Objectives: This paper presents another way to perform breast augmentation with a better security index in regard to the shape as well as to preservation of breast functions normally lost in classical procedures

Introduction: Most called retromuscular or retropectoral breast augmentations consist in inserting the prosthesis behind only one muscle on the anterior aspect of the thorax, that is to say behind the pectoralis major muscle. This will mean that one third or one quarter of the prosthesis will not have a muscular cover and will be in direct contact with the breast tissue. The lack of muscle protection on a part of the prosthesis surface will lead to a possible wrinkling show on the inferior lateral aspect of the breast and a possible “double-bubble” phenomenon added to loss of erogenous nipple sensation.

Materials / method: Loss of erogenou sensation is a consequence of the prosthesis insertion behind the only pectoralis major muscle, interrupting often the continuity of three intercostal nerves (4th, 5th and 6th), responsible of erogenous sensation of the nipple. Our approach promotes the insertion of the prosthesis behind the four muscles of the anterior thorax through a low incision in the anterior oblique and the serratus anterior, and an undermining superiorly, medially and laterally to create a pocket behind the four muscles of the anterior thorax.

Results: The prosthesis is placed behind the four next muscles: the Anterior Oblique, the Serratus Anterior, the Pectoralis Minor and the Pectoralis Major. This surgery will preserve the functions of the three intercostals nerves, thus the erogenous sensation and contraction of the nipple and nipple areola complex.

Conclusion: The Total Retromuscular breast augmentation pervoys an optimal muscle covering for the prosthesis avoiding many problems encountered in the simple retropectoral augmentation and guaranties the preservation of the erogenous sensation of the nipple

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