The concept of breast augmentation surgery has traditionally been focused o
n implant volume; however, with the advent of anatomic breast implants in t
he 1990s, a new era in breast augmentation surgery started, focusing on dim
ensions and proportions. In 823 patients, 1676 anatomic cohesive silicone g
el implants have been used in this series. To date this is the world's larg
est experience from one center. The concept of using these types of implant
s is very different from other augmentation techniques and many considerati
ons in the preoperative assessment have to be respected for optimal results
. A "decision tree" has been constructed to aid the surgeon to choose the r
ight type of implant. In this article, advantages and disadvantages, indica
tions, contraindications, preoperative measurements and considerations, sur
gical technique, postoperative management, and results are presented.