There are many choices that the prospective breast implant patient has to make. Aside from who will be the surgeon, the patient has to think about what size implant she wants, what style, location (above or below the muscle), and which incision. The following discussion explores one of the most basic decisions concerning the implant style: Round or Anatomic?

Implants come in two basic styles -- round or anatomic. These refer to the shape the implants has when you put it flat on a table; as will be discussed, it's a little more complicated when you consider what it will look like in the woman.

A round implant is exactly that: when placed on a table, it is round when viewed from the top. You can rotate it as much as you want in any direction and it will still look the same. From the side, it's the same idea -- an equally curved dome that looks the same regardless of how you rotate it.

Not so with the anatomic or "teardrop" implant. This implant was originally intended for use in breast reconstruction patients (i.e., after a mastectomy). The natural breast, of course, is not round. Instead, it is conical or teardrop-shaped, with a gentle slope at the top and more of the breast in the lower half.

The teardrop implant, therefore, most closely mimics that shape and is ideal for total breast replacement. Unlike the round implant, the anatomic implant has only one correct orientation and must be lined up exactly right, if it is rotated even a few degrees, it will not look right.

What about the typical cosmetic breast enlargement patient? While there are different opinions and preferences on this matter, two recent studies have shed some interesting light. At first glance, the anatomic implant makes the most sense and, indeed, it is the first choice of many surgeons.

However, aside from the fact that it only comes in a textured form (and for many reasons, many patients and surgeons prefer a smooth implant -- which is a topic for another time), on closer examination it may not prove to be the best choice. First of all, most patients who have even a little breast tissue already have more of it in the lower half of the breast (I.e., a little sagging).

Adding more volume to that part of the breast actually compounds the "problem" rather then compensating for it. So a round implant, that has relatively more of its volume in its upper half (than an anatomic implant) actually does a better job of putting more where you need it more, assuming you'd like more of a balance.

What about the round, ball-like look that everyone hates? Well, first of all, you normally get that when you have too big of an implant for the space in question; i.e., when a woman has chosen an implant that's a little too big for her chest. It's hard not to "go for it" when you're choosing an implant size, but it may be well worth being a little conservative in this regard.

After all, it's much easier to make yourself look a littler larger for selected occasions than it is to make yourself look a little smaller. One woman who felt she had gone a little too big later told me that she looked great in evening wear and lingerie, but for just hanging around the house in sweats, it was a bit much. Secondly, not everyone hates that look; some people actually like it (assuming it's not too extreme).

There's more. The above discussion is based on the implants shape when they're sitting on a table. What happens in a real-live woman? This question was addressed in two recent studies and the impressive results confirm what many surgeons have believed for a while. In a patient, a round implant often behaves more anatomically then an anatomic implant! A number of women with implants were examined radio-graphically (i.e., using x-rays) in both the standing and lying positions.

The found that when women are standing, the implants are similar. The anatomic implant assumes an anatomic (teardrop) shape. This is not surprising, but what is surprising is that so does the round implant! When a woman is standing, gravity works on the implant to pull a little more of it down and, from the standpoint of x-rays, both implants are relatively teardrop-shaped and therefore anatomic.

So what happens when a woman lies down? Well, the anatomic implant remains "anatomic," i.e., it maintains it's teardrop shape. The problem is, you don't always want that when you lie down. Natural breasts fall to the side when a woman lies down, so ironically, the anatomic implant is less anatomic when a woman is lying down.

And what about the round implant? Because it has less of a framework then the anatomic implant (which is what keeps it anatomic), the round implant, once again, responds to the forces of gravity and more closely mimics the natural breast. They found, quite remarkably, that the round implant falls to the side much more then the anatomic.

(In fairness, it should be pointed out that, with time, some women have had "dishing out" of their round implants (i.e., they become wider and flatter with time) to a greater extent then the anatomic implants do. Anatomic implants, however, because they're textured and have more of a framework, remain stiffer then many round implants, particularly smooth ones.

In sum, therefore, when you use the term "anatomic" you may need to be prepared to define it carefully. DO you mean anatomic on a flat surface like a table, or in a woman? In views of the above, one could definitely argue that the round implant is actually more anatomic then the anatomic implant.