Skip to Main Content

Yale Breast Reconstruction Program

At the Yale Breast Reconstruction Program, we understand that breast reconstruction is a deeply personal decision. Some women decide to have reconstruction after a mastectomy or lumpectomy to restore the shape, size, and appearance of their breast. While every woman has her own reasons for choosing breast reconstruction, studies have shown that breast reconstruction improves self-image, self-confidence, and quality of life.

In most cases, reconstruction can be performed immediately following a mastectomy during the same operation. In other cases, reconstruction should be performed in a delayed fashion, after the breast cancer is fully treated. Regardless of timing, federal law mandates that all insurance companies pay for breast reconstruction when a mastectomy is indicated.

The Yale Plastic and Reconstructive Surgery faculty members are highly qualified to treat even the most complicated breast reconstruction cases. Our faculty is dedicated to helping women feel whole after breast cancer. We work with cancer doctors, so that reconstruction can be incorporated into a patient's treatment process.

Meet Our Breast Reconstruction Faculty

  • Assistant Professor of Surgery (Plastic)

    Kamal Addagatla, MD, MS, DABS, is an Assistant Professor of Plastic and Reconstructive Surgery in the Department of Surgery and cares for patients as part of Smilow Cancer Hospital in Trumbull, Bridgeport, and New Haven, CT. Dr. Addagatla specializes in reconstructive surgery, aesthetic breast and body contouring, and the breadth of general plastic surgery. Having completed training and board certification in both General Surgery and Plastic Surgery, including a Fellowship in Reconstructive Microsurgery at Yale New Haven Hospital, he has a particular interest and expertise in post-mastectomy reconstruction and is able to offer implant-based or autologous options such as local tissue (i.e. latissimus and TDAP) and free flap (i.e. DIEP, PAP, and stacked flaps) reconstructive techniques for his patients. In the past, Dr. Addagatla has contributed to both research and quality improvement studies, as well as participated in teaching junior residents and medical students at the Stamford Hospital, an affiliate of the Columbia University Vagelos College of Physicians and Surgeons, where he served as Academic Chief Resident, at Cooper Medical School of Rowan University where he served as Clinical Instructor, and at Yale New Haven Hospital where he served as Clinical Microsurgery Fellow. He is passionate about quality improvement in healthcare and educating the community about post-mastectomy reconstruction and advances in microsurgical techniques. He is a member of the American Society of Plastic Surgeons and the American Society of Reconstructive Microsurgery. Dr. Addagatla takes great pride in delivering the highest quality of care to his patients in a relaxed and comfortable environment. When he meets with patients, he aims to understand their individual goals and desires, and create a surgical plan that is uniquely ideal for them.
  • Assistant Professor of Surgery (Plastic)

    Haripriya Ayyala, MD is a board-certified plastic and reconstructive surgeon. She was named Assistant Professor of Plastic and Reconstructive Surgery in the Department of Surgery and cares for patients as part of the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center. She graduated Alpha Omega Alpha from the George Washington University School of Medicine and completed her residency in plastic surgery at Rutgers followed by a fellowship in reconstructive microsurgery at Memorial Sloan Kettering Cancer Center. Dr. Ayyala’s clinical interests include post-oncologic reconstruction focusing on microsurgical techniques. She is an expert in autologous (DIEP, PAP, DUG) flap reconstruction, re-sensation techniques, and also specializes in direct to implant breast reconstruction. Dr. Ayyala is also one of the few surgeons in the northeast that performs immediate lymphatic reconstruction at the time of axillary lymph node dissection and offers lymphovenous bypass and vascularized lymph node transplant procedures. Her research interests include robotic microsurgery, evaluation of outcomes after complex reconstruction, innovation in microsurgery, and operative efficiency. She has numerous grants in robotics as well as breast reconstruction. She has authored over 50 peer-reviewed publications, serves on multiple national committees, and is committed to mentorship in surgical education.
  • Associate Professor of Surgery (Plastic); Vice Chair Diversity, Equity, and Inclusion, Surgery

    Dr. Paris D. Butler is an Associate Professor in the Division of Plastic Surgery at the Yale University School of Medicine. He is also the inaugural Yale Department of Surgery Vice Chair of Diversity, Equity, and Inclusion (DEI).  After completing his undergraduate education as a student athlete (basketball) at Roanoke College, he attended medical school at the University of Virginia School of Medicine. He completed a general surgery residency at the University of Virginia and subsequently completed his plastic surgery training at the University of Pennsylvania (UPenn). He is board certified by both the American Board of Surgery and the American Board of Plastic Surgery and is a Fellow of the American College of Surgeons (FACS).  Dr. Butler has clinical interests in breast reconstruction, breast reductions, breast lifts, post bariatric body contouring, scar/wound management, breast implant removal, and aesthetic surgery (abdominoplasty, breast augmentation, liposuction, etc.).  During his general surgery training, he completed a postdoctoral research fellowship at Stanford University where he studied keloid biology. Additionally, he obtained a Master’s in Public Health (MPH) from Univ. of California-Berkeley in health policy and management with special certificate in minority health. Dr. Butler is nationally recognized for his dedication to reducing healthcare disparities along ethnic lines – something he has approached with research, policy, and teaching in mind. Prior to being recruited to Yale, Dr. Butler served for 6 years on the faculty as an Assistant Professor of Surgery at the University of Pennsylvania.  In addition to his clinical appointment,  he also served as the Associate Designated Institutional Official (DIO) of Underrepresented in Medicine (UIM) Affairs in UPenn’s Graduate Medical Education office. He has received numerous teaching awards in addition to recognition for his work with mentoring residents, medical, undergraduate, and high school students aspiring to enter the field. Dr. Butler has authored over 75 publications in peer-reviewed journals and the lay press. He serves on the American College of Surgeons’ (ACS) Committee on Healthcare Disparities, Society of Black Academic Surgeons’ (SBAS) Membership, Financial, and Health Equity Committees, the American Board of Surgery’s (ABS) Governance Committee, the Association of Academic Surgeons’ (AAS) Diversity Committee, the American Council of Academic Plastic Surgeons’ (ACAPS) DEI Committee, and is Chair of the American Society of Plastic Surgery’s (ASPS) Diversity and Inclusion Committee.
  • Section Chief of Reconstructive Oncology , Division of Plastic and Reconstructive Surgery

    Siba Haykal MD, PhD, FRCSC, FACS is the Section Chief of Reconstructive Oncology for the Division of Plastic and Reconstructive Surgery within the Department of Surgery. She is a double board certified plastic and reconstructive surgeon. She is an acclaimed specialist in microsurgical reconstruction and has research interests in breast reconstructive surgery and vascularized composite allotransplantation. Dr Haykal has years of experience delivering care for breast cancer patients. She specializes in autologous based reconstruction (DIEP, PAP, SGAP, TUG, LD). She offers innovative techniques for restoration of breast sensation and immediate lymphatic reconstruction following lymph node dissection. She has extensive experience in treating lymphedema and offers lymphovenous bypass and lymph node transplantation. Dr Haykal also offers microsurgical treatment for skin cancers, head and neck cancers and sarcomas. Dr. Haykal graduated from the University of Ottawa Faculty of Medicine in 2007 as class valedictorian and silver medalist, and subsequently completed her residency training in Plastic and Reconstructive Surgery at the University of Toronto in 2016. During her residency, she completed a PhD in tissue engineering and regenerative medicine with a focus on tracheal reconstruction. She obtained numerous grants and awards including the Canadian Institute of Health Research Vanier Canada Graduate Scholarship for her project, “Evaluation of the Immunogenicity of Decellularized Allografts for Airway Transplantation.” Dr. Haykal pursued fellowship training in microsurgical reconstruction at the Albany Medical Center in New York. She joins the Yale School of Medicine Department of Surgery after serving as an Assistant Professor at the University of Toronto and University Health Network. She was named as an honoree for “Canada's Top 40 under 40” for 2021 and is the recipient of American Society for Reconstruction Microsurgery – Women in Microsurgery Travel Scholarship and the Hugh G. Thomson Humanitarian Award for her clinical, academic and research work, and is the author of over 50 peer-reviewed publications including a study published in Advanced Healthcare Materials illustrating the utility of recipient-derived stem cells for airway repair.
  • Frank F. Kanthak Professor of Surgery (Plastics); Chief, Plastic & Reconstructive Surgery; Professor, Surgery

    Dr. Bohdan Pomahac is Division Chief of Plastic & Reconstructive Surgery. Dr. Pomahac joined the Yale Surgery and Smilow Cancer Hospital community from Brigham and Women’s Hospital and Harvard Medical School, where he was the Roberta and Stephen R. Weiner Distinguished Chair in Surgery and Director of Vascular Composite Allograft Transplantation program.A pioneer in his field, Dr. Pomahac’s team performed the first three full-face transplant procedures in the United States, and the first successful bilateral upper extremity transplantation in the Northeast. Dr. Pomahac made Brigham and Women’s Hospital the world leader in vascularized composite transplantation completing 10 face and 3 bilateral hand transplants.Dr. Pomahac’s expertise adds to a growing portfolio of destination programs in the Division of Plastic & Reconstructive Surgery at Yale, which has grown into a multidisciplinary enterprise—with novel programs across Connecticut, including wound healing, craniofacial surgery, melanoma treatment, targeted muscle reinnervation, breast reconstruction, and cutting-edge research in machine learning and 3D printing.
  • Assistant Professor of Plastic Surgery

    Dr. Vasquez is a board-certified Plastic Surgeon and Assistant Professor of Plastic and Reconstructive Surgeon at the Yale School of Medicine with special interests in aesthetic surgery, cancer and trauma reconstruction. He completed a general surgery residency, an independent plastic surgery residency, an orthopaedic hand and upper extremity fellowship, as well as served in the U.S. Navy as Battalion Surgeon. Dr. Vasquez was the Past President of the Medical Staff of Bridgeport Hospital. He is an active member of the American Society of Plastic Surgeons (ASPS) as well as the American Society for Aesthetic Plastic Surgery (ASAPS) and served on several professional committees. He has developed a strong reputation in the greater Fairfield community.

Breast Procedures

Implant Reconstruction
For women who choose implant reconstruction, this usually involves multiples stages. Reconstruction begins at the time of mastectomy with tissue expanders placed on the chest wall beneath the skin and muscle. The expander is filled with saline (salt water) every two to three weeks in the office under local anesthesia, until the breast reaches the desired size. The patient then returns to the operating room for an outpatient procedure to remove the tissue expander and place a permanent implant. In some cases, specifically in women with a smaller breast size, a one-stage implant reconstruction may be possible with placement of a permanent implant at the time of mastectomy.

The benefit of implant-based breast reconstruction is that it involves a shorter operation, shorter recovery, and it limits the operative field to the chest. It does have its limitations. Since the implant is a foreign body, it can potentially be felt and seen beneath the skin of the breast. It can also become infected, which would potentially require removal of the implant. Excessive scar tissue (capsular contraction) can also form around the implants causing them to become firm, change shape/position, and be tender. Severe capsular contraction (Baker Grade 3 and 4) may require revisional surgery. Finally, implants have the potential to rupture, and may need to be replaced over a patient’s lifetime.
Autologous Breast Tissue Reconstruction

The main alternative to implant-based reconstruction is using a patient's own tissue to reconstruct the breast. The most common donor site for this tissue is the abdomen, but there are several other choices.

The use of abdominal tissue for breast reconstruction was first described in 1982, and has been named the Transverse Rectus Abdominis Myocutaneous (TRAM) flap. An alternative to a pedicled TRAM is a free TRAM (fTRAM). To decrease the risk of bulge, hernia, or abdominal weakness following breast reconstruction, the Deep Inferior Epigastric artery Perforator (DIEP) flap was developed. This flap also uses the tissue of the lower abdomen, but it does not use any of the abdominal wall muscles. A flap that completely spares dissection of the abdominal muscles and fascia is the Superficial Inferior Epigastric Artery (SIEA) flap.

For women who do not have enough tissue on their abdomen to use for a TRAM, DIEP, or SIEA flap, there are a number of other areas on the body where tissue can be obtained. The buttock can supply either a Superior Gluteal Artery Perforator (SGAP) or an Inferior Gluteal Artery Perforator (IGAP) flap. The thigh can supply a Transverse Upper Gracilis (TUG) flap. Or a combination of the patient's own tissue from the back (latissimus flap) can be used in conjunction with implant-based reconstruction.

Is it important to remember that reconstruction is a process and is rarely completed in one operation. Typically, four months after the initial operation, revisions are performed to improve the contour of the reconstructed breast. If only one breast was treated, the other breast may need a lift, reduction, or augmentation to improve the balance and appearance between both breasts. In addition, nipple areolar reconstruction may be performed if the nipple was removed at the time of mastectomy.

Nipple and Areola Reconstruction
At Yale Plastic and Reconstructive Surgery, we understand that for many women the nipple is an integral part of feeling that their breast reconstruction is complete. Most often, the nipple and areola are removed with the breast tissue at the time of mastectomy. This is done because the nipple contains ducts that carry the risk of developing breast cancer. Regardless of the form of breast reconstruction, the initial post-operative result is left without a nipple. Several months after the initial surgery, a nipple and areola can be reconstructed with local flaps, grafts, or a combination of the two. Additionally, tattooing can be used to restore color to the nipple and areola.