When choosing silicone gel implants, the decision for round or anatomic can be confusing. The concept behind the anatomic implant is to give the breast a natural, teardrop shape. The first question that I have is whether the anatomic implant truly gives the breast a more natural appearance when compared to the round implant. In a standing position, when implanted in the breast, both implants actually assume the anatomic or teardrop shape. Although implant manufacturers will often show in advertisements a picture of a round and anatomic implant sitting on a flat surface, with the anatomic implant maintaining an anatomic shape, this is not a valid comparison to what happens in the breast pocket that is created at the time of surgery. A number of studies published in the plastic surgery literature have shown both implants maintaining an anatomic shape. A couple of recent studies have shown something even more interesting. In a controlled study, plastic surgeons were asked to evaluate photos of women with round and others with anatomic breast implants. Most were unable to tell the difference between the two. In a separate ultrasound study, which was actually done to determine the incidence of rotation of the anatomic implant, which can cause breast shape deformity, there was a surprising incidence of “silent” rotation of the anatomic implant, in other words, it had rotated and the patient and plastic surgeon could did not know it had. This brings up the obvious question. If the anatomic implant is supposed to give an anatomic shape to the breast because it maintains its shape better, yet the shape of the breast didn’t change significantly with rotation of the implant, is it actually doing what it claims to do? The answer is sometimes. What is more clear is that the anatomic implant does its best job in the context of breast reconstruction after a mastectomy. In cosmetic breast augmentation however, the advantage is minimal to none for most patients, yet the cost is considerably higher and there is a chance of breast shape deformity with implant rotation. That is the reason the I choose to perform breast augmentation with the round, smooth cohesive silicone gel implant. The results are predictable. There is nothing wrong with choosing an anatomic implant, the main thing to understand is that the same result is often achieved with the round implant at less cost.