We appreciate Dr. Swanson's letter regarding our article, "Breast Augmentation with Microtextured Anatomical Implants in 653 Women: Indications and Risk of Rotation."1 We agree with Dr. Swanson that breast augmentation with high-projection anatomical implants cannot replace the mastopexy procedure. It would be wrong to offer a breast augmentation without a mastopexy to patients with severe ptosis who wish a substantial lift of the nipple-areola complex. However, we do believe that breast augmentation with anatomical implants is a valuable alternative to augmentation-mastopexy in a subgroup of women with glandular ptosis and a low position of the nipple-areola complex. These patients can benefit from smaller scars, less extensive surgery without the risk of nipple necrosis,2,3 and a lower cost but at the expense of lowering the inframammary fold.4 We attribute the benefit of anatomical implants in this selected group of patients with a low position of the nipple-areola complex to the shorter arch from the lower pole of the implant to the point of maximum projection compared with round implants, which limits the lowering of the inframammary fold.5Our study is limited by the retrospective design with the lack of a standardized measurement tool, but it is strengthened by the large sample size, and it provides the readers with data on the reoperation rate due to malrotation of the implant. Dr. Swanson correctly states that our discussion of the beneficial properties of anatomical implants is based on first principles. WeThe authors correctly reference the much lower risk of breast implant-associated anaplastic large-cell lymphoma when using Siltex implants compared with more aggressively textured devices. 7 However, patients are generally intolerant of a small risk that is entirely avoidable (by using smooth implants). Today, the link to macrotextured devices is no longer "suspected" and the frequency is no longer considered "rare."A recent meta-analysis 8 that included a unique randomized study 9 was unable to substantiate an aesthetic benefit for shaped implants. The breasts may appear short and wide using Mentor CPG implants (see Figure, Supplemental Digital Content 1, http://links.lww.com/ PRS/F397). Smooth, round implants are less expensive for patients. It is also much easier to inventory round implants and simply select volume and profile. 5 Importantly, breast implants, even high-profile implants, do not simulate the effect of a mastopexy. 3 For the woman who lifts her breasts by the cups of her hands and says, "this is what I want," a (vertical) augmentation/mastopexy 10 is most likely to achieve her goals. 3,10 The importance of photographic standardization has been known for decades, 11 but (oddly) this safeguard is often ignored. 12 Forgoing this requirement inevitably leads to erroneous conclusions. 13 Treatment recommendations must be based on objective and reproducible measurements 2-4 as opposed to first principles. That is the goal of evidence-based medicine. 14