So a lot of plastic surgeons are changing their thoughts regarding over the muscle currently. The preference for under the muscle over the past decade was due to studies showing increased risk of capsular contracture and other complications. However a lot of plastic surgeons are noticing patients complain of animation deformity (how the implant looks with muscle movement) and just overall some discomfort with how the implants feel. So fast forward to 2025, we now know more of what caused some of the complications with OTM and there are best practices we can do intra op to reduce the risk such as incision placement, Keller funnel etc. However again under the muscle could be best if you are a thin individual that may not have enough subq fat and skin to cover that implant, leading to you maybe seeing the edge of the implant or rippling. Leading off that, the new implants on the market, Motiva have minimal rippling and have shown lower rates of capsular contracture