Dr. Michael Zenn is an internationally recognized expert in breast reconstruction surgery for cancer patients. He has literally written the book. His two-volume textbook, Reconstructive Surgery, has become essential reading for plastic surgery residents and practicing surgeons world-wide. His more than 20 years of experience has culminated in his creation of his patented Zenn Delay technique. This revolutionary reconstructive method extends conservation of the nipple and breast skin following mastectomy to most patients, even those previously irradiated. It also significantly reduces the rates of complications while reducing the standard treatment time for most patients by months. Plastic surgeons around the world now employ the Zenn Delay technique to give their patients safer, more efficient care and more aesthetically appealing outcomes.

Dr. Zenn offers unparalleled experience and skill in breast reconstruction. Before entering private practice to support Raleigh and Durham-area patients, he served as a Full Professor and the Vice Chief of Plastic Surgery at Duke University Medical Center and was director of its residency program for ten years. He encourages women who are considering mastectomy to learn about all of their treatment options and to explore the advantages of the Zenn Delay.

The Limitations of a Traditional Breast Reconstruction

A breast reconstruction that uses your own nipple and breast skin tends to provide a more beautiful and natural-looking result. Breast cancer surgeons only need to remove the underlying breast tissue during mastectomy. There is ample skin and a nipple complex already present, so why does everyone need to go through months of tissue expansion to have a breast reconstruction?

The reason: the success of a nipple sparing mastectomy depends on having a good blood supply after the surgery. The nipple and breast skin require this blood supply to survive but are accustomed to receiving that blood supply from the breast tissue, and loss of breast skin or a nipple can be as high as 50%. For this reason, most patients don’t receive the final breast implant in the same operation as their mastectomy.

Instead of placing an implant during a mastectomy, most Raleigh and Durham-area plastic surgeons place a tissue expander. The tissue expander has much less volume than the required implant, which places less pressure on sensitive mastectomy skin and encourages the development of new blood supply. Since the process of tissue expansion takes months, this gives the nipple and breast skin time to regain the blood supply they need. Breast reconstruction patients then have a follow-up operation to replace the tissue expander with a final implant approximately 3 months after mastectomy.

However, tissue expanders present several drawbacks:
  • Tissue expansion requires weekly office visits and can be painful.
  • It can be challenging to wear clothes and look “normal” during the expansion process.
  • During the months that the tissue expander is in place, the aesthetics of the natural breast may diminish. Skin elasticity, contracture, and the expansion process can change the position of the nipple and the appearance of the breast, making re-creation of the natural breast difficult, if not impossible.

Dr. Zenn has decades of practice in nearly every established breast reconstruction technique. Through this experience, he has found that patients only need about two weeks after the mastectomy for their nipple and breast skin to regain a proper blood supply, not months as traditionally taught. He developed the Zenn Delay around this understanding.

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The Zenn Delay Method of Breast Reconstruction

Through the Zenn Delay, women can have a mastectomy and ultimately have breasts that look attractive and natural appearing in and out of clothing. The technique extends the option of nipple sparing mastectomy to patients who previously were felt not to be candidates: large breasted women, previously irradiated women, and previously operated upon women.

Mastectomy. The process begins when you have a nipple sparing mastectomy with your breast surgeon. You may not be offered this option unless you specifically ask your surgeon.  If they do not perform this type of mastectomy, consider a second opinion with a surgeon who is familiar with the technique. You will not have reconstruction the same day as the mastectomy. This is the confusing part for most patients, who feel they are not getting the “best care” if they do not wake up with a new breast. However, this is the magic of the technique – allow the skin and nipple to recover some before stressing it further with an implant or an expander. Honestly, waking up with an expander is hardly a breast. The only thing the breast surgeon needs to do for the reconstruction is place a surgical drain to prevent fluid buildup.

Pre-operative examination. One week after your mastectomy, you will have an appointment with Zenn Plastic Surgery so that Dr. Zenn can examine the incisions and remove the drain. You will then spend one more week waiting for your reconstruction. Dr. Zenn’s paper shows that 2 weeks of “delay” is an adequate time for the skin to have recovered from the mastectomy. During the 2 week delay, the chest will be flat but pain will be minimal. In fact, most of the pain of an immediate reconstruction comes from placing the implant or expander under the chest muscle and not from the mastectomy. Women who receive a partially filled tissue expander will generally look flat as well during this time and do not start their expansion for at least 2 weeks.

Breast reconstruction. Two weeks following your mastectomy, you will have your plastic surgery procedure. Dr. Zenn will re-create your breast mound by placing a breast implant in front of the pectoralis muscle, which itself is not actually needed for the reconstruction. This greatly reduces any postoperative pain from the procedure.  Since the skin and nipple now have excellent blood supply, there are much less concerns about anything not surviving.

The Zenn Delay will use your own breast skin, preserve the nipple complex, and replace your breast tissue with an implant months before the traditional tissue expander approach. Plastic and Reconstructive Surgery, the official academic journal of the American Society of Plastic Surgery, has reported on patients in the Raleigh and Durham area who Dr. Zenn has treated with the Zenn Delay. Even high-risk patients did extremely well following surgery and benefited from outstanding cosmetic results with no nipple or skin loss.

More About Dr. Zenn’s Work in Breast Reconstruction

Since publishing in Plastic and Reconstructive Surgery, Dr. Zenn has traveled around the world presenting to other practitioners about the Zenn Delay. He is committed to seeing the technique adopted as the standard of care so that women everywhere can have the most beautiful outcomes while at the same time lowering healthcare costs by eliminating the need for surgery months later and preventing complications from occuring.

Patients in the Raleigh and Durham region rely on Dr. Zenn for breast reconstruction and cosmetic surgery in part because of his expertise and experience. He is a past Program Director for the American Society of Reconstructive Microsurgery’s Annual Meeting and serves as a board examiner for the American Board of Plastic Surgery. His post-graduate training includes two years of Plastic Surgery at the Massachusetts General Hospital / Harvard University in Boston and a prestigious breast and facial surgery fellowship at Memorial Sloan Kettering Cancer Center in New York City. It is his unique background, his extensive surgical experience, his eye for aesthetics, and his dedication to his patients that translates to personalized, excellent care.

Breast Reconstruction Resources

These “Pink Sheets”, written by Dr. Zenn, include descriptions of the various Breast Reconstruction surgery options for our Breast Cancer patients. Click here to download and learn more information about your options as a patient.

Breast Cancer Resource Directory of North Carolina: http://bcresourcedirectory.org
Information on Ameona breast forms: www.thebreastcaresite.com
Information on saline and silicone gel implants: www.breastimplantsafety.org

If you have been diagnosed with breast cancer or at high risk for breast cancer and are considering mastectomy as part of your treatment, learn more about breast reconstruction with the Zenn Delay. Patients in the Raleigh and Durham area can contact Zenn Plastic Surgery online or by phone at (919) 480-3885.