This study reports on complications, outcomes, re-operation rates and patient satisfaction among 1529 women who received 3495 implants for augmentation, reconstruction and secondary revision surgery. This population-based study was comprised of all implant recipients treated at a multidisciplinary breast center between June 1979 and June 2004 (25 years). The database was constructed and maintained in Excel and statistical analysis was performed using SAS 8.2. Outcomes were compared among various surgical procedures, different implant surface textures and different filler materials. Outcomes monitored included rate of capsular contracture, incidence of infections, hematomas, undesirable waviness, saline implant deflation and gel implant rupture. Additionally, the rates and reasons for re-operation were determined. Our data reveal that implant recipients have a significant incidence of local complications and a relatively high rate of re-operation. The most common overall indication for re-operation is capsular contracture. The incidence of symptomatic capsular contracture does not diminish after one or two years. The longer implants are in place, the greater the cumulative risk for developing contracture. The occurrence of hematomas significantly increases the risk of contracture. Polyurethane foam-covered implants are associated with a dramatically reduced rate of contracture. This benefit of the polyurethane foam surface persists for at least ten years following implantation and is not associated with an increased risk of other complications. Mechanically textured implants do not afford significant protection against contracture and are associated with an increased risk of wrinkling and waviness as well as a higher rate of saline deflation. In spite of a significant incidence of side effects and local complications, as well as a high rate of re-operation, implant recipients in all categories expressed a high overall degree of satisfaction.