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 a mastectomy. It also significantly reduces the rate of complication, while reducing the standard treatment time for most patients by months.

Dr. Zenn Offers Unparalleled Experience and Skill in Breast Reconstruction

Plastic surgeons around the world now employ the Zenn Delay technique to give their patients safer, more efficient care. As well as, more aesthetically appealing outcomes.

Before entering private practice to support 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.

Dr. Zenn encourages women who are considering mastectomy surgery to learn about all of their treatment options. Additionally, to explore the advantages of the Zenn Delay technique for breast reconstruction.

The Limitations of a Traditional Reconstructive Breast Surgery

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 patients 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 plastic surgeons place a tissue expander. The tissue expander has much less volume than the required implant. This 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.

The Zenn Delay Technique For Breast Reconstruction

Through  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.


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 at Zenn Plastic Surgery in Raleigh, NC. During your appointment, Dr. Zenn examines your incisions and removes the drains. You will then spend one more week waiting for your reconstruction. Dr. Zenn’s paper shows that two weeks of “delay” is an adequate time for the skin to have recovered from the mastectomy. During the two 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 surgery. Women who receive a partially filled tissue expander will generally look flat as well during this time. This is because the actual expansion does not begin 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. This entire process is complete 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 who Dr. Zenn has treated with  Zenn Delay. Even high-risk patients did extremely well following surgery and benefited from outstanding cosmetic results with no nipple or skin loss.

Have you tested positive for abnormal BRCA1 or BRCA2 gene? Are you considering a preventative mastectomy? Call Zenn Plastic Surgery in Raleigh, North Carolina today at  (919) 480-3885 and schedule a consultation. Meet with Dr. Zenn to learn more about his technique, Zenn Delay for breast reconstruction.

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. Doing so will enable women everywhere to have the most beautiful outcome possible. And at the same time lower healthcare costs by eliminating the need for additional surgeries and limiting complications.

Patients in Raleigh, NC and beyond rely on Dr. Zenn for breast reconstruction and cosmetic surgery. They do so because of his expertise and experience, and not without mention his strong attention to detail. Most patients seeking breast reconstruction are referred from friends who have had reconstruction with Dr. Zenn or from direct referrals from oncologists familiar with his technique.

Dr. Zenn is honored to serve as a board examiner for the American Board of Plastic Surgery, the official board of Plastic Surgery. His post-graduate training is unparalleled and includes two years of Plastic Surgery at the Massachusetts General Hospital / Harvard University in Boston. Additionally, Dr. Zenn trained at Memorial Sloan Kettering Cancer Center in New York City. Where he did a prestigious breast and facial surgery fellowship. It is his unique and extensive surgical background along side his eye for aesthetics, 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.

American Society of Plastic Surgery

American Cancer Society


U. S. National Library of Medicine

Food and Drug Administration