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Since their introduction in 1993, anatomical implants have provided a more natural appearance in breast augmentation, and many surgeons advocate their use and promote the good aesthetic results. However, the risk of implant rotation makes some of them reluctant to use these devices. The rotation rate varies among authors.The authors present a 6.5-year series of 531 patients who underwent primary breast augmentation with macrotextured anatomical implants in a Swedish facility performed by one consultant surgeon (P.M.). The authors examined the rotation rate and the correlation with possible predisposing factors such as preoperative breast cup size, childbirth, and body mass index.A total of 20 implants (1.88 percent; 95 percent CI, 1.15 to 2.89 percent) in 19 patients (3.58 percent; 95 percent CI, 2.17 to 5.53 percent) were rotated. In one patient (0.22 percent), both implants rotated, whereas in the remaining patients, the rotation was unilateral. The authors were unable to establish a statistically significant correlation between implant rotation and previous childbirth or increased body mass index. However, there was a relation between rotation rate and preoperative breast cup size that showed an upward trend as the cup size increased from A to C.The authors believe that if the implant is correctly selected and the operation is performed meticulously with proper pocket dissection, the rotation rate is minimal and it should not be considered a disadvantage for the use of anatomical implants.Risk, III.