Background <p>Silicone-based implants are widely used in plastic surgery for aesthetic and reconstructive purposes. However, their foreign-body nature carries risks such as infection, protrusion, deformities, and pain. While capsule formation is a natural physiological response, capsular contracture is a frequent long-term complication for which no definitive treatment exists. Extracorporeal shock wave therapy (ESWT), which utilizes ultrasound-based sound waves, has shown potential in modulating inflammation and fibrosis. This study investigates the effects of smooth and rough silicone implants on capsule contracture, with or without ESWT.</p> Methods <p>Thirty-two female rats were randomized into four groups: rough implant (RG), rough + ESWT (RESG), smooth implant (SG), and smooth + ESWT (SESG). ESWT was administered on days 14 and 28 to RESG and SESG. After six weeks, rats were sacrificed, and skin-capsule tissue and intracardiac blood samples were collected for histopathologic and biochemical analysis.</p> Results <p>Histologically, RESG showed significantly higher loose connective tissue (<i>p</i> = 0.013) and increased dense connective tissue (<i>p</i> = 0.0124). No significant differences were observed in other parameters. Biochemically, serum TNF-α, MMP-9, and TGF-β levels differed between groups (<i>p</i> = 0.0210, <i>p</i> = 0.0019, <i>p</i> = 0.0001, respectively). TNF-α and TGF-β levels were highest in RG and significantly reduced in RESG. Fibronectin levels were also higher in RG than ESWT groups.</p> Conclusions <p>This study supports the effects of ESWT on tissue remodeling and early inflammation. The findings suggest that ESWT has the potential to regulate fibrotic and inflammatory processes. Therefore, further studies evaluating the effects of implant surface properties and physical interventions such as ESWT on capsular contracture are warranted.</p> Level of Evidence <p>Not gradable. </p>