Never in my 20 years have I been able to perform one reconstructive surgery and get final results like this! Natural-appearing breasts that look great both in and out of clothes. Why now? Two recent developments: “Nipple sparing mastectomy (NSM)” and “Direct to implant (DTI)” breast reconstruction. Hands down, NSM allows the plastic surgeon to get the best cosmetic results by using your own breast skin, preserving your nipple complex and replacing your breast tissue with a breast implant. The real question: Why go through traditional skin stretching with an expander for months when you already have plenty of breast skin? The answer: You don’t have to!

You are right to ask why haven’t we been doing this for years. It turns out that the breast skin gets its blood supply from the very breast tissue being removed during mastectomy. Accordingly, the skin has an incidence of skin and nipple loss of up to 40% in some studies. And you can’t tell for sure during surgery who will have the problem. Because of this, plastic surgeons usually choose to place a tissue expander at the time of mastectomy and perform skin expansion over months to “delay” the skin so it can gain extra blood supply and create extra skin if needed. But you really only need about two weeks to gain that “delay” effect. Enter the Zenn Delay.

While some surgeons can perform mastectomy and implant placement at the same operation, it is risky. Sometimes we can use intraoperative imaging, like SPY technology, to evaluate blood supply for safety before placing implants, but most do not. Some women are just at too high a risk for an “immediate” reconstruction with NSM and DTI due to previous surgery, large breasts, drooping breasts, or previous radiation.

In an effort to give more women the chance to be candidates for immediate reconstruction, I invented the Zenn Delay procedure:
  1. Have a NSM with your own breast surgeon using any skin incision they prefer.  No reconstruction is performed.  A surgical drain is placed.
  2. See Dr. Zenn one week after your surgery.  The incisions are inspected and the drain is removed.
  3. Two weeks after the first surgery have a second operation, now with Dr. Zenn and have your final implant placed above the muscle (pre-pectoral).  Oh yeah, you don’t have to have your pectoralis muscle used either!

Read the article of Dr. Zenn featured on ABC 11 Eyewitness News.

My series of patients was reported in Plastic and Reconstructive Surgery, the top academic journal for board-certified plastic surgeons and the official journal of the American Society of Plastic Surgery. Patients did beautifully, even when they were high risk, including previous surgery, previous radiation, large breasts and droopy breasts. Importantly the cosmetic results were outstanding. Click the article to read it.

Since publishing the article, I have traveled the world presenting the technique to plastic surgeons everywhere. For all its benefits, especially better cosmetic and no tissue expansion, I truly believe the Zenn Delay will be the standard way implant breast reconstruction will be performed in the future.

If you have been diagnosed with breast cancer or at high risk for breast cancer (i.e.. BRCA gene positive) and are considering mastectomy as part of your treatment, ask your surgeon about having a Zenn Delay. For more information or to schedule a consultation, call (919) 335-9013 or email

Dr. Zenn lectures about his Zenn Delay technique to surgeons from around the world at an international conference in Mumbai, India.