The Zenn Delay is changing lives! Never in my 20+ years in practice have I been able to perform reconstructive breast 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.”

The Zenn Delay Protocol

  • Meet with Dr. Zenn before mastectomy surgery.
  • Dr. Zenn speaks with your breast surgeon to discuss the details of the reconstruction. He emphasizes to your surgeon that they should perform their standard mastectomy.
  • Have NSM with a breast surgeon of your choice. Dr. Zenn is not present for this procedure and your surgeon only performs the mastectomy. No reconstruction is performed. A surgical drain is placed.
  • See Dr. Zenn in the office one week after your surgery. He will evaluate your healing and remove the drains. He will then have you try on implants and choose your size. This is the only reconstructive technique that you can choose your implant and cup size!
  • Two weeks after the mastectomy, you have your reconstruction with Dr. Zenn. The final implant is placed and your reconstruction is finished!

Nipple-Sparing Mastectomy

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 your surgeon removes during your mastectomy. Accordingly, the skin has an incidence of skin and nipple loss of up to 50% 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.

While some surgeons perform mastectomy and implant placement at the same operation, it is risky. And some women who are felt to be too high a risk for “immediate” breast reconstruction are not even offered immediate reconstruction with NSM. High risk status can be due to previous surgery, large breasts, drooping breasts, or previous radiation. And surgeons do not agree who should be excluded.

 “In an effort to give more women the chance to be candidates for immediate reconstruction, I invented Zenn Delay”

Benefits of Zenn Delay

  • Lowest incidence of skin and nipple necrosis (1-2%).
  • Lowest incidence of infection and implant loss.
  • Pathology is back at one week before any reconstruction is performed.
    • Positive margins or unexpected pathology can be addressed without interfering with reconstruction.
    • Patients with positive margins have can have further cancer surgery at the time of final implant placement without the need of a tissue expander.
  • Prior to surgery, patient chooses implant and cup size by trying on implants during office visit. This is only possible because the chest is flat after mastectomy.
  • Patients with previous radiation, excessive breast size and droop, and previous surgery are excellent candidates for Zenn Delay!
  • The Zenn Delay procedure is relatively pain free because the reconstruction is performed over the muscle (pre-pectoral). It is placement of implants or expanders under the muscle that causes pain.
  • Surgical drains are usually removed three days after Zenn Delay. This compares with 2-3 weeks for other techniques.
  • Reconstruction is COMPLETE two weeks after mastectomy. With the traditional expander technique, patients are just beginning 2-3 months of tissue expansion at two weeks and still need a second surgery to place final implant.
  • Utilizing natural breast skin as opposed to expanded skin allows for a more natural and attractive cosmetic result.

Read the Article

Raleigh plastic surgeon, Dr. Michael Zenn of Zenn Plastic Surgery, offers a unique reconstruction technique for breast cancer patients. Zenn Delay gives many women the chance to immediately have their breasts reconstructed following their mastectomy.


Do you have breast cancer? Are you at high risk for breast cancer (i.e. BRCA gene positive)? Considering mastectomy as part of your treatment? Ask your surgeon about the Zenn Delay.