The Borenstein Maneuver: A Surgical Technique to Narrow the Breast and Add Projection.

INTRODUCTION

The Borenstein maneuver is a powerful surgical tool used to achieve 3 goals:

Narrowing of the wide breast.

Adding projection.

Gradually reducing tension from the final skin closure.

The ptotic breast has a significant lateral vector of ptosis, which is often overlooked during the surgical markings and planning. Correction of only the inferior vector may lead to wide breasts with a lack of projection. We aim to use the laterally displaced breast tissue by gathering it toward the cleavage line and create the projection.

The Borenstein maneuver was created as a tradeoff between width and projection.

The Borenstein maneuver during breast reduction surgery is demonstrated in Figure 1 (also see Video [online], which displays the Borenstein maneuver during breast reduction surgery. Note how the maneuver progressively narrows the breast while adding projection. Compare the reduced right breast to the untouched left breast in relation to the chest wall). The maneuver follows these steps:

Fig. 1.

Transverse section of the Borenstein maneuver. After the skin flaps are raised, 2–4 horizontal figure of 8 sutures are placed in the freshly exposed breast tissue edges. When tied down, these sutures imbricate the breast tissue, narrowing the breast while adding projection. In the illustration, the final result is achieved after repeating the maneuver three times. Note the 3 layers of imbrications.

Video 1.

Borenstein Manuever. Video from “The Borenstein maneuver – A surgical technique to narrow the breast and add projection”

Two thin dermal flaps, similar to facelift skin flaps, are developed on either side above the pillars.

Two to four horizontal figure of 8 sutures are placed in the freshly exposed breast tissue edges above the pillars. When tied down these sutures imbricate the breast tissue, narrowing the breast while adding projection.

The previous step is repeated as needed.

When the wanted breast shape is achieved, the excess thin skin strips are cut, and the tension-free dermal edges are approximated using an absorbable intradermal suture.

DISCUSSION

Most breast reduction methods debulk the breast tissue and repackage it within a tailored skin “brassiere.” Some authors have attempted to address the shaping of the central portion of the breast via pillar sutures, or suspending the pedicle in attempts to augment the upper pole. The Borenstein maneuver enables the surgeon to address the lateral breast tissue and use it to add projection and reduce the tension on the skin during final approximation and skin closure (Fig. 2). The maneuver can be used in breast reduction, mastopexy, augmentation mastopexy, and oncoplastic breast reconstruction to achieve the same goals in different variations.[1,2]

Fig. 2.

Sagittal section of the Borenstein maneuver. A, Resection of breast tissue for breast reduction. B and C, Pillar shaping sutures. D,Borenstein maneuver repeated with three layers of imbrication.