Dr. Zenn is internationally recognized as an expert in breast reconstruction. He was the lead reconstructive breast surgeon at UNC-Chapel Hill from 1996-2000, and Duke from 2000-2017. During this time, he worked closely with other oncological professionals on interdisciplinary teams at the UNC Lineberger Comprehensive Cancer Center and the Duke Cancer Center. Dr. Zenn has an abundance of experience in every established breast reconstruction technique. In fact, he was the first plastic surgeon to perform DIEP Flap reconstructions in North Carolina nearly two decades ago.
Dr. Zenn literally “wrote the book” on breast reconstruction. His two-volume textbook, Reconstructive Surgery, is essential reading for plastic surgery residents and surgeons world-wide. After performing thousands of breast reconstructive surgeries over his career, he is proud to have developed the Zenn Delay procedure for immediate breast reconstruction.
This revolutionary reconstructive surgery allows for conservation of the nipple and breast skin following mastectomy for most patients, even those previously irradiated. Additionally, it significantly reduces the complication rates and shortens the standard treatment time by several months. Plastic surgeons around the world now perform the Zenn Delay to deliver safer and more efficient care. And ultimately, a more aesthetically pleasing cosmetic result.
Limitations of Traditional Reconstructive Surgery
Breast cancer surgeons need only remove the underlying breast tissue during a mastectomy. Due to the popularity of the Nipple Sparing Mastectomy (NSM), once that tissue has been removed, there is ample skin and a nipple complex still present. This is good because we know a breast reconstruction that uses a patient’s own nipple and breast skin will yield a more beautiful and natural-looking cosmetic result. Traditionally, the way to accomplish this is to have patients go through months of tissue expansion to prepare the breast for final reconstruction.
The Role of Tissue Expanders
The success of a nipple sparing mastectomy depends on having good blood supply after the surgery. The nipple and breast skin require this blood supply to survive but are accustomed to receiving blood supply from the breast tissue that has now been removed. Therefore, complications including loss of breast skin or the nipple can be as high as 50% if reconstruction is attempted at time of mastectomy. For this reason, most patients don’t receive a final breast implant in the same operation as the mastectomy.
Instead, most plastic surgeons place a tissue expander at the time of mastectomy. Initially, this tissue expander has much less volume than the required implant. Therefore, it places less pressure on sensitive mastectomy skin thereby encouraging the development of new blood supply. Since the process of tissue expansion usually takes months to achieve the desired size, the nipple and breast skin have time to regain the blood supply they need to survive.
Approximately three months after mastectomy and expander placement, breast reconstruction patients undergo a follow-up operation to replace the now fully expanded tissue expander with a final implant.
Despite widespread use, tissue expanders present several drawbacks:
- Tissue expansion requires weekly office visits to slowly increase volume of the expander.
- Patients report that as the expander increases in size, the breast area is painful (tight).
- It can be challenging to wear clothes and look “normal” during the expansion process.
- During the months the tissue expander is in place, the aesthetics of the natural breast may permanently diminish. Skin elasticity, scar contracture, and the expansion process can change the position of the nipple and the appearance of the breast. This makes re-creation of the natural breast difficult, if not impossible.
Dr. Zenn has decades of experience in nearly every established breast reconstruction technique (DIEP, SIEA, GAP, TUG, etc.). As a result of this experience, he discovered that patients actually only need about two weeks after the mastectomy for their nipple and breast skin to regain a proper blood supply, not months as traditionally thought. Based on this revelation, Dr. Zenn created the Zenn Delay.
The Zenn Delay Technique for Breast Reconstruction
With the Zenn Delay, women have a mastectomy and ultimately final reconstruction with breasts that look attractive and natural in just two weeks. 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 women with previous breast surgery.
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 about “nipple sparing” as not all breast surgeons perform this surgery. If the surgeon does not perform this type of mastectomy, consider a second opinion with a surgeon who is familiar with this very common technique.
You will not have reconstruction the same day as the mastectomy. This is the confusing part for some patients. However, herein lies the magic of the technique – allow the skin and nipple to simply recover. No additional stress on the area with an implant or an expander. The only thing the breast surgeon needs to do to prepare for the reconstruction is place a surgical drain to prevent fluid buildup.
One week after mastectomy, you will see Dr. Zenn at Zenn Plastic Surgery in Raleigh, NC. During this appointment, Dr. Zenn examines incisions and removes the drains. The second week following mastectomy, lay low and continue to heal. Dr. Zenn’s research shows that two weeks of “delay” is optimal for the skin to recover from the mastectomy. During the two-week delay, the chest will be flat and pain minimal (in fact, most of the pain with immediate reconstruction comes from placing the implant or expander under the chest muscle — not from the mastectomy.) By comparison, women who receive a partially filled tissue expander at the time of mastectomy will generally look flat as well during this time, because proper expansion won’t begin for at least two weeks.
Two weeks following mastectomy, you will have your plastic surgery procedure. Dr. Zenn will re-create your breast by placing a breast implant in front of the pectoralis muscle. This placement greatly reduces any potential postoperative pain. Because the skin and nipple now have excellent blood supply, there is less concern about them not surviving.
The Zenn Delay uses a patient’s own breast skin and preserves the nipple complex when safe from a cancer standpoint. Breast tissue is replaced with an implant two weeks after mastectomy. Reconstruction finished!
This entire process is complete months before the traditional tissue expander approach.
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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 the Zenn Delay. Even high-risk patients did extremely well after this surgery and benefited from outstanding cosmetic results with no nipple or skin loss.
Since publishing his findings in 2015, Dr. Zenn has traveled the world presenting to and teaching other surgeons about the procedure. Plastic surgeons around the world now perform the Zenn Delay to deliver safer and more efficient care.
Dr. Zenn is committed to seeing the technique adopted as the standard of care, enabling women everywhere to have the most beautiful outcome possible.
More information on Zenn Delay here.
Find the original scientific article here.