The two most commonly performed incisions are through the fold under the breast (called the inframammary fold) and around the nipple (periareolar). Other approaches are in the armpit (axillary) and belly button (umbilical). Approximately 95% of my augmentations are done via the fold incision as it provides the best visualization and a highly acceptable scar that is hidden by a bikini top. If you have very small breasts, a periareolar incision may be preferable and gives the exact same results. I do not perform the armpit and belly button approaches because I feel that they don’t provide the same consistently excellent and reliable results that I achieve with the others.
Placing the implants behind the muscle provides multiple advantages including protection from capsular contracture, more accurate mammography, better coverage and camouflage of the implant, and protection from bottoming out. If adequate breast tissue is present, the implant will be well-disguised regardless of being placed above or below the muscle.  Also, since silicone implants are used almost exclusively again, subglandular implants provide much more consistent and excellent results.  Implants placed above the muscle is also called subglandular or suprapectoral augmentation.  It is an excellent choice that can provide superior results when properly indicated.  Indications for subglandular augmentation include minimal ptosis, bodybuilding or fitness models that pose while flexing, desire to avoid a breast lift or personal preference.  The most common indication for implants above the muscle is bodybuilders that are posing and are bothered by movement of the implant while flexing.  There is a slightly higher risk of capsular contracture but the risk is still approximately only 10%.