Breast Cancer

A mother and daughter Embracing at home.

Trusted Breast Cancer Care That Puts You First

You take care of everyone else, and we commend you for that. Now, it’s time to take care of you. We understand a breast cancer diagnosis can change your life, and you’re not alone. Our nationwide network of oncologists and multidisciplinary care teams is committed to helping you heal, supporting you and making you feel comfortable every step of the way — caring for you in body, mind and spirit.

Higher Survival Rates

Early detection methods and advanced treatment options have helped more breast cancer patients be cancer-free. Our survival rates have reached record highs and we’re uncovering more life-saving research every day, paving your road to recovery with innovation and hope.
A Legacy of Innovation

As one of the most active clinical trial participants in the country, we’re breaking ground for the future and giving eligible patients access to promising new treatments every single day.
Whole-Person Care

We see patients as family. And just like family, we help you overcome cancer with heart-felt, whole person care. We’re here to help you heal, whether it’s an innovative new treatment, support from a survivor, or a shoulder to lean on.

A breast cancer diagnosis impacts more than your body; it affects you emotionally and impacts your daily life as well. And our expert oncologists are here to help you heal in body, mind and spirit. No matter your diagnosis, rest assured that you’re in good hands with us.

As you begin your treatment journey, it’s essential to realize that beyond traditional treatment, everything you eat, the way you feel, and your mindset can play a role in your healing. It’s why we examine your whole health before prescribing your individual treatment plan. It’s also important to know that because no two breast cancer diagnoses are the same, not every patient will follow the same course of treatment. Instead, your oncology team will personalize your course of treatment strategically, prescribing individual therapies as needed. Depending on your diagnosis, your treatment plan may include some, none, or all of the therapies below.

Chemotherapy: Understanding Chemotherapy
Chemotherapy Treatment: What to Expect
Nothing matters more to us than getting you well, and getting you home. Depending on the specific characteristics of cancer, chemotherapy may play an essential role in successfully treating it. From the moment you arrive for your chemo treatment, one of our nurses will be there to greet you and guide you, keeping you and your loved one informed, comfortable, and in good spirits throughout your visit.
How Does Chemotherapy Work?
Using a combination of specialized drugs, chemotherapy has the power to destroy or slow down the growth of fast-growing cancer cells by finding and eliminating them, wherever they may be. It can be administered intravenously or orally. Chemotherapy has long been used to treat breast cancer. As new drugs are emerging worldwide, we’re always exploring how to make them available to you through clinical trials. Depending on your stage of breast cancer, your dedicated oncology team will determine which drug or combination of drugs makes the most sense for you.
Chemotherapy may be the only treatment you receive, or, more commonly, used in combination with surgery and/or radiation therapy. Along the way, we're here to help however we can, answering any questions and helping you stay strong and optimistic before, during, and after your treatment.
Learn More About Chemotherapy Treatment
Radiation: Understanding Your Treatment Options
Radiation Therapy: What to Expect
While radiation therapy is one of the most common treatments for breast cancer, at AdventHealth Cancer Institute, we do it with uncommon expertise, guidance, and compassion. Using sophisticated radiation technology, we can target tumors with amazing precision, easing your pain and leaving healthy tissue untouched. Depending on your diagnosis, your dedicated team may recommend radiation alone, but in many cases, we combine it with surgery, chemotherapy, and hormone therapy.
How Does Radiation Therapy Work?
Our oncology experts take an individualized approach to every patient’s treatment plan. Using the same energy as X- rays, radiation therapy targets specific areas of the body, shrinking tumors and killing cancer cells by damaging their DNA.
When treating breast cancer, radiation therapy is usually delivered one of three ways:
External radiation delivers radiation in a concentrated beam to keep nearby healthy tissue unaffected.
Internal radiation is guided by ultrasound or using our MRI-guided HDR brachytherapy.
Intraoperative radiation therapy (IORT) combines radiation treatment with a surgical procedure, meaning shorter treatment times and more efficient dosing.
Throughout your treatment, your nurses and your radiology care team are there to keep you and your support system informed, comfortable, and uplifted.
Learn More About Radiation Therapy
Surgery: Surgery: What to Expect
If surgery is part of your treatment plan, it’s reassuring to know that your health is in the hands of specialized surgeons. As a recognized leader in breast cancer care, we’re helping patients heal through innovative surgical care day in and day out.
Options for Surgery
Breast cancer surgery can be individualized depending on your specific diagnosis, tumor biology, and extent of tumor in your breast. After reviewing your medical history and test results, your medical team will recommend the most effective treatment plan for you. Surgery may be the only treatment you need, but may be used in combination with chemotherapy and/or radiation therapy.
The extent of breast cancer surgery is typically one of the following pathways:
Lumpectomy, or partial breast surgery, is used for tumors that can be removed in their entirety while leaving a significant amount of the normal breast tissue remaining. This would then in most circumstances be followed by radiation.
Mastectomy means the entire breast is removed and is usually for larger tumors, or for those tumors associated with a high-risk genetic finding.
Another pathway is the use of surgery following the completion of chemotherapy first.
Regardless of what procedure you need, from pre- to post-op, we’ll be there with open arms to ease you into your recovery.
Learn More About Oncology Surgery
Hormonal Therapy: Hormonal Therapy and Targeted Therapy
We're always looking for ways to help you heal faster and feel more comfortable.
We’re always looking to improve your care. One way we can try to do that is with hormone therapy, an innovative treatment that may be an option depending on your specific cancer and your personal care plan. Hormone therapy blocks receptor sites on tumors that otherwise signal breast cancer cells to grow, helping to slow or even stop the disease in its tracks.
How Does Targeted Therapy Work?
Rather than risk hurting healthy cells, targeted therapy harnesses the power of new proteins, genes, and drugs to attack cancer cells while keeping healthy cells safe. So while we’re treating your cancer with all our strength, we take every measure we can to help you keep yours.
Learn More About Hormonal Therapy and Targeted Therapy
Reconstruction: After a mastectomy or double-mastectomy due to breast cancer, some women choose to undergo breast reconstruction surgery. At AdventHealth, we offer patients a variety of reconstruction options that are tailored to their individual needs.
Among these is an innovative reconstructive option known as a deep inferior epigastric perforator (DIEP) flap procedure.
During DIEP flap surgery, fat, skin and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Your surgeon carefully reattaches the blood vessels of the flap to blood vessels in your chest using microsurgery. No muscle is used to rebuild the breast.
Benefits of DIEP Flap Surgery
DIEP flap breast reconstruction offers advantages over alternative surgical options including:
Reduced post-operative pain
Faster recovery times
Lower risk of losing abdominal muscle strength vs. other procedures
Uses your body’s own tissue to rebuild the breast, making it a more natural option in comparison to prosthetic reconstruction
Doesn’t degrade over time like many synthetics do
Is DIEP flap right for you?
While DIEP flap breast reconstruction is popular, it isn’t for everyone. If you fall into any of the following categories, you are likely not a good candidate for the DIEP flap procedure.
Thin women who don’t have enough extra belly tissue needed. However, there is a newer “stacked” approach that can sometimes work for women in this category. The surgeon takes tissue from the lower abdomen and stacks it to provide the volume needed to reconstruct the breast.
Women who have already had certain abdominal surgeries, including colostomy (surgery that attaches the large intestine to an opening in the abdominal wall) or abdominoplasty (tummy tuck).
Women whose abdominal blood vessels are small or not in the best location to perform a DIEP flap.
Experienced Care You Can Trust
The DIEP flap procedure requires special surgical training and expertise in microsurgery.
We have an *AAAASF-certified operating room with recovery on the premises — ensuring a high-quality surgical and postsurgical care experience.
Our team has performed over 900 microvascular procedures in the last seven years.
Our team approach reduces our average operating times by six-to-eight hours less than the national average.
*American Association for Accreditation of Ambulatory Surgery Facilities
Lymphedema Treatment: Lymphedema is a chronic disease that occurs due to an abnormality or injury to the lymphatic system. When the lymphatic system is injured or abnormal, the lymph fluid cannot drain, and this protein-rich fluid accumulates in the interstitium, leading to debilitating swelling of the involved body part. The most common cause of lymphedema in the U.S. is after cancer treatment, where lymph nodes are removed as part of the treatment, leading to a blockage of the lymphatic flow.
How does lymphedema occur in breast cancer?
The lymphatic collectors of the arm drain in most patients through the lymph nodes of the axilla or armpit. The lymphatic collectors of the breast also drain into the same lymph nodes. In breast cancer treatment, the armpit nodes are sampled to determine if the cancer has spread beyond the breast. This is called a sentinel node biopsy.

Sometimes, if there is cancer in the sentinel lymph node, most of the armpit nodes have to be removed to prevent the cancer from coming back into the axilla (a procedure called an axillary lymph node dissection, or ALND). The risk of developing lymphedema after a sentinel lymph node biopsy is small, but it can still occur. The risk of developing lymphedema after most armpit nodes are removed is much greater, especially if the axilla is treated with postoperative radiation therapy. The risk of developing lymphedema in this situation is about 20 to 30%.
What are the risk factors for developing lymphedema in breast cancer?
Removing the majority of the axillary lymph nodes (ALND)
Removing more than six nodes when performing a sentinel lymph node biopsy
Receiving radiation to the axilla
Performing a mastectomy without reconstruction
Having a BMI greater than 30
Developing a postoperative infection
Developing a postoperative hematoma (blood clot in the wound)
Receiving Taxane therapy
What do I do if I develop lymphedema of the arm?
At AdventHealth, we have a surveillance program that will follow you closely after you have started your breast cancer treatment. We will measure your arm volumes over time and use bioimpedance to determine if you are developing an early form of lymphedema. If you do develop lymphedema, you’ll be referred to our lymphatic therapist, who will begin therapy immediately. Our therapists are located on multiple campuses for your convenience.

Therapy consists of performing complete decongestive therapy (CDT), which includes:
Manual lymphatic drainage: a form of light massage to remove lymph fluid from the affected arm
External compression: usually a custom-fitted compression garment for the hand and arm that applies pressure on the skin and tissues to prevent the lymph fluid from reaccumulating
Exercise with compression: encourages the flow of lymph fluid out of the arm as the muscle contracts against a compression garment
Skin care: this consists of using moisturizing lotion to keep the skin of the arm soft and supple and prevent cracks in the skin, which can lead to an infection (cellulitis)
What happens if I have lymphedema of the arm, and I don’t get it treated?
Once you develop lymphedema, the swelling will worsen over time unless it is controlled with CDT. Once significant swelling sets in the lymph fluid in the tissues, it causes inflammation of the interstitial space, leading to the accumulation of fat cells and scarring, which is referred to as lipo fibrosis. Once you develop this condition, it becomes very difficult to treat the involved arm. You are also at risk of developing serious infections of the arm called cellulitis that may require hospitalization for intravenous antibiotics.

Lymphovenous Bypass
One of the operations we perform is called a lymphovenous bypass in the axilla. This operation is performed before you develop lymphedema and is done at the time of the removal of the lymph nodes (ALND) during breast cancer treatment. In this operation, the lymphatic channels or collectors draining the arm are identified in the armpit using a variety of special dyes. Once the nodes are removed, these channels normally scar down, leading to lymph flow blockage and possible lymph fluid accumulation and lymphedema. Instead of allowing them to scar down, these collectors are sewn directly into an adjacent vein, allowing the lymph fluid to flow directly from the collectors into the vein. This operation significantly decreases the risk of developing lymphedema after an axillary lymph node dissection.

Vascularized Lymph Node Transfer (VLNT)
If you develop lymphedema and are controlling your symptoms with CDT, we can improve the symptoms by performing a vascularized lymph node transfer. In this operation, four to six lymph nodes are removed from another part of your body and transferred to the armpit of the involved arm. The lymph node packet is attached to an artery and a vein in the armpit to provide nutrition and oxygen to the “transplanted” nodes. Once healing has occurred, the lymph nodes will begin forming new lymph channels that will help drain the excess lymph fluid accumulated in the involved arm. The use of custom compression garments is still necessary, albeit the duration of wear per day may be reduced.

Liposuction Debulking
Once you have developed more advanced lymphedema of the arm, the tissues swell not only due to the accumulation of lymph fluid but also due to the accumulation of fat cells and scar tissue. This lipo fibrosis causes the arm to enlarge further, and neither the VLNT nor LVB procedures will help reduce the arm volume. The only means of volume reduction is to remove the fat and scar layer with liposuction. This is often called lipo debulking or suction-assisted protein lipectomy (SAPL). This operation is usually performed six months after the VLNT procedure if necessary.

We take a collaborative, multidisciplinary approach to your cancer care, which means different types of specialists work together as a team to determine the most personalized and effective treatment plan for you.

Ashley D. Anderson, MD

Breast Surgery
Kyle Bowers, MD

General Surgery, Breast Surgery
Tutu Cheng, MD

Plastic Surgery
Lauren Cornell, MD

Breast Surgery
John Cox, MD

General Surgery, Breast Surgery
Sandra Deniz, MD

Breast Surgery
Kristine Freyaldenhoven, MD, FACS

General Surgery
Michelle Han, MD

Breast Surgery
Walter Hayne, MD

Breast Surgery
Catherine Hwang, MD

Radiation Oncology
Jeremy John, MD, MPH, FACS

Breast Surgery, Surgical Oncology
Kamy Kemp, MD

Breast Surgery
Richard Klein, MD, MPH, CLT-LANA, FACS

Plastic Surgery
Bettina Lowe, MD, FACS

General Surgery
Eleftherios (Terry) Mamounas, MD, MPH, FACS

Breast Surgery Medical Director — Central Florida

Breast Surgery
Borys A Mascarenhas, MD

Surgical Oncology, Breast Surgery
James Mayo, MD

Plastic Surgery
Devina McCray, MD

Breast Surgery
Wassim McHayleh, MD

Hematology and Oncology
Quintessa Miller, MD, FACS

Plastic Surgery
Amber Orman, MD, DipABLM, FACLM

Radiation Oncology
Sabrina Pavri, MD, MBA, FACS

Plastic Surgery
Frances Phang, MD, FACS

Breast Surgery
Rachel Raphael, MD

General Surgery
Donovan Rosas, MD

Plastic Surgery
Anupama Saigal, MD

Breast Surgery
Roxanne Sylora, MD

Plastic Surgery
Paul Williams, MD

Breast Surgery, General Surgery

We provide world-class evaluation and care for patients with diagnosed breast malignancies. Our physicians from multiple specialties work together to provide the full range of medical and surgical therapies and will work with you to determine which ones are best for you.

Reducing the Time Between Your Diagnosis and Treatment: During your appointment, you’ll meet with your care team — including a medical oncologist, breast surgeon and radiation oncologist — who will discuss an appropriate course of treatment and answer your questions, all within a single visit. This coordinated approach to your care means you spend less time traveling to medical appointments and start receiving the care you need, faster.
Benefits of our Multi-Specialty Approach: Patients meet with a medical oncologist, breast surgeon, and radiation oncologist as part of single, coordinated visit all on the same day
Customized treatment planning in a single visit
Centralized care means you spend less time traveling to medical appointments
Begin your treatment as quickly as possible

We know you may have many questions about your breast health, and our board-certified physicians and expert care teams are here to help. Find answers to commonly asked questions about breast cancer below.

Question: What are the early signs of breast cancer?
Answer:
The early signs of breast cancer vary from person to person, but common signs of breast cancer include:
A new lump in the breast or armpit
Breast skin irritation or dimpling
Change in size or shape of the breast
Nipple discharge (other than breast milk)
Pain anywhere in the breast
Pain in the nipple area
Redness or flaky skin near the nipple
Thickening or swelling of the breast
Question: What causes breast cancer, and what are the risk factors?
Answer:
Although the exact cause of breast cancer is currently unknown, it occurs when breast cells begin to grow and divide abnormally. Several factors can lead to a diagnosis, including lifestyle factors, hormones, gene mutations and inherited genes.
Continue Reading

When it comes to risk factors for developing breast cancer, there are factors that you can and can’t control. Risk factors you can’t control include:
Aging
Exposure to diethylstilbestrol (DES)
Genetic mutations at birth
Having dense breasts
Personal or familial history of breast cancer or other diseases
Previous treatments using radiation therapy
Reproductive history
Risk factors you can control include:
Being overweight
Drinking alcohol
Not being physically active
Taking hormones
Talk with your doctor about certain lifestyle changes you can make to prevent a breast cancer diagnosis.

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Question: At what age should breast cancer screenings or mammograms start?

Answer:

For women at an average risk of developing breast cancer, it’s recommended that breast cancer screenings and mammograms begin at age 40. However, if you’re experiencing early symptoms of breast cancer before the age of 40, or you have a family history of breast cancer, schedule an appointment with your provider to get screened. Breast cancer is highly treatable and curable when it’s caught early.
Question: How is breast cancer diagnosed?

Answer:

Breast cancer can be diagnosed through several methods. If your mammogram results indicate abnormality, your doctor can refer you to a breast oncologist for further diagnostic imaging. Our imaging specialists use breast ultrasounds, MRIs and biopsies to diagnose breast cancer with pinpoint accuracy.
Question: What type and stage of breast cancer do I have?
Answer:
To know what type and stage of breast cancer you have, you must visit your oncologist. Breast cancer is staged from the earliest form, Stage 0, to the most severe, Stage 4. The most used staging system is the American Joint Committee on Cancer (AJCC). This system considers seven key aspects when staging your cancer, including:
The size of the tumor
The spread to nearby lymph nodes
The spread to distant sites
Estrogen receptor status
Progesterone receptor status
HER2 status
Grade of the cancer
Question: What are the treatment options for breast cancer?
Answer:
If you’ve been diagnosed with breast cancer, your care team will talk to you about your options. You may receive local or systemic treatments. Local treatments include surgery and radiation therapy. Specific local treatments include:
Continue Reading

Lumpectomy
Mastectomy
Radiation
Systemic treatments include medications given by mouth, injected into a muscle or directly into your bloodstream. These treatments can reach cancer cells anywhere in the body. Systematic treatments for breast cancer include:
Chemotherapy
Hormonal therapy
Immunotherapy
Targeted therapy
Talk with your care team to determine which treatment option is best for you and your unique diagnosis.

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Question: Can breast cancer spread, and where does it usually spread?

Answer:

Yes, breast cancer can spread to other parts of the body, known as metastatic, or Stage 4, breast cancer. The process of breast cancer spreading is called metastasis, and it occurs when cancer cells break away from the tumor and travel to other parts of the body. These cells travel through the lymphatic system, which is the network of lymph nodes and blood vessels throughout your body. Most commonly, breast cancer spreads to the bones, lungs, brain or liver.

When you’re facing a breast cancer diagnosis, you and your family deserve wholehearted care close to home, and that’s what you can expect from us at the AdventHealth Cancer Institute. We offer specialized treatments for both common and rare breast cancers — all coordinated through a trusted national network. Explore our locations or ask your dedicated Cancer Care Navigator to help you find the best place for the care you need.

Breast Cancer

Trusted Breast Cancer Care That Puts You First

Rising Above Breast Cancer

Higher Survival Rates

A Legacy of Innovation

Whole-Person Care

Breast Cancers and Conditions We Treat

Understanding Your Treatment Options

Meet Our Expert Providers

Breast Cancer Experts Who Specialize in You

National Leader in Cancer Care

ACR Breast Imaging Center of Excellence

ACR Accredited for Radiation Oncology

NAPBC Accredited Breast Center

Multidisciplinary Breast Cancer Care

Embrace Your Full Network of Cancer Care

Clinical Trials

Get a Second Opinion

Patient Resources

Answering Your Breast Cancer Questions

Q:Question: What are the early signs of breast cancer?

Q:Question: What causes breast cancer, and what are the risk factors?

Q:Question: At what age should breast cancer screenings or mammograms start?

Q:Question: How is breast cancer diagnosed?

Q:Question: What type and stage of breast cancer do I have?

Q:Question: What are the treatment options for breast cancer?

Q:Question: Can breast cancer spread, and where does it usually spread?

Find Breast Cancer Care Near You

Question: What are the early signs of breast cancer?

Question: What causes breast cancer, and what are the risk factors?

Question: At what age should breast cancer screenings or mammograms start?

Question: How is breast cancer diagnosed?

Question: What type and stage of breast cancer do I have?

Question: What are the treatment options for breast cancer?

Question: Can breast cancer spread, and where does it usually spread?