4. Is over the muscle better than under the muscle placement?
There are multiple advantages to placing the implant underneath the muscle. Many techniques are described of exactly where the best position is. I like to use the muscle to support the implant in nearly all cases. There are a few exceptions. In general the muscle will help to support the implant and minimize bottoming out over time. The muscle also helps to create a covering layer over the implant allowing a smoother transition from the top of the chest onto the implant surface. There is a gentle sloping effect that is created by the muscle. The risk of capsular contraction is also reduced when the implant is placed under the muscle. The feel of the breast is also more natural with less rippling since the muscle provides more natural tissue to cover the implant. Your plants that are placed above the muscle tendon stretch and thin the breast overtime leading to a lower position of the implant. More rippling is felt and there is a higher risk of contractures. 

5. Where is the best placement for my incision?
Incisions can be made in the armpit, around the nipple, or underneath the breast. When the under arm is used the scar can be visible or bothersome when you shave. It is a tight space to push the implant through so nerve injuries are also common along the inside part of the arm. The tissues on the outside part of the breast are often disrupted when pushing the implant through and can lead to the implants falling out to the sides overtime.this will be more noticeable when the patient is leaning back or laying on a pool chair. We have all seen that space between the breasts all too often. This often requires corrective surgery where sutures have to be replaced on the outer portions of the breast pocket to force the implants back to the center. And incision around the areola can be used if the pigment of the areola as distinct in the circumference is large. It's also preferable to use this site if you also need to have a skin lift around the nipple. This will minimize having extra scars. It is important to note that capsular contraction or does occur at a higher rate when the nipple site is used. The most common incision used and the one I prefer the most is only 1 inch long and is at the lower portion of the breast just above the crease. This site has the least problems over time. It allows for perfect placement of the implant with minimal disruption of outer tissues or nerve injuries. Future surgeries to replace the implants or revise the implant pockets almost always requires this incision. So it makes sense to just use it the first time and have that same scar available for future surgeries. 

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