You take care of everyone else. Now it’s time to focus on you. At AdventHealth, formerly Florida Hospital, Cancer Institute, you’ll find a multidisciplinary approach to treating breast cancer and a caring staff dedicated to you. With outcomes that exceed the national average, we focus our energy on healing you, supporting you, and making you feel comfortable along the way.
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.
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.
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.
Our breast program is an American College of Radiology (ACR) Breast Imaging Center of Excellence, an accreditation that recognizes the most advanced breast imaging technologies and procedures.
Accredited by the American College of Radiology (ACR) for Radiation Oncology by meeting guidelines including equipment, treatment-planning, patient-safety and quality control standards.
We’re accredited by the National Accreditation Program for Breast Centers (NAPBC) for excellence in program leadership, clinical services, research, community outreach, professional education and quality improvement. We offer access to clinical trials, new treatments, genetic counseling and supportive, patient-centered services like care navigation.
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.
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.
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.
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.
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 or may be used in combination with chemotherapy and radiation therapy.
Lumpectomy, or breast conserving surgery, is used for tumors that can be removed in their entirety while leaving a significant amount of normal breast tissue remaining. This would then in most circumstances be followed by radiation to the breast. For patients with large or ptotic breasts, this can be combined with a breast reduction or lift — a procedure called an oncoplastic reduction — to eliminate the defect caused by the lumpectomy as well as to optimize post-surgical aesthetic outcomes and reduce the neck and back pain caused by large breasts.
Mastectomy means the entire breast gland is removed and is usually for larger or multifocal tumors, or for those tumors associated with a high-risk genetic mutation. Mastectomies can be unilateral (one sided) or bilateral (both sides); nipple-sparing (preserving the breast skin, nipple and areola while removing the breast gland) or skin sparing (preserving the breast skin while removing the breast gland, nipple and areola) - our surgical team will guide you through the decision process so that you can choose the option that is right for you.
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.
We're always looking for ways to improve your care, help you heal faster and feel more comfortable.
One way we 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. Another form of hormonal therapy reduces the estrogen levels in your body, depriving the cancer cells from estrogen that they need to grow.
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.
After a mastectomy due to breast cancer, most women choose to undergo breast reconstruction surgery. This typically starts during the same procedure as the mastectomy, known as ‘immediate reconstruction’, although it can also be performed in a delayed fashion if needed At AdventHealth, we offer patients a variety of reconstruction options that are tailored to their individual needs.
Breast reconstruction with a silicone or a saline implant is the most common form of reconstruction. Depending on tumor extent, breast anatomy and patient goals, sometimes the implant can be placed at the same time as the mastectomy, or a patient may need the skin reshaped with a temporary device called a tissue expander before they get their final reconstruction.
Breast reconstruction with your own tissue is also an option for many patients. The most popular form of tissue-based reconstruction is a procedure called the deep inferior epigastric perforator (DIEP) flap.
During DIEP flap surgery, fat and skin from the lower abdomen, along with the blood vessels that supply the tissue, are taken and moved up to your chest to rebuild your breast. Your plastic 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:
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:
What other tissue-based options are offered?
If you are not a good candidate for a DIEP flap, skin and fat may be taken from the back of the upper thigh (PAP flap), the “love handle” region (LAP flap) or the buttocks (SAGP/IGAP flaps) to reconstruct the breast.
Do I have to have reconstruction?
Definitely not. Breast reconstruction is elective, and some patients elect to have an “aesthetic flap closure”, where the plastic surgery will remove the excess skin left behind after the mastectomy, to ensure that a post-mastectomy prosthesis can be worn (if desired) without issues.
Do you offer the Resensation® procedure?
Our plastic surgeons offer an innovative new technique to repair the nerves to the nipple to certain patients who are undergoing nipple-sparing mastectomies, so that they can regain sensation to the nipple and breast skin.
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 more than 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 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?
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 the following:
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.
Is there an operation that can help if I do develop lymphedema?
In our Center for Comprehensive Lymphatic Care (CCLC), we offer many surgical options for treating lymphedema.
Lympho-venous Bypass
One of the operations we perform is called a Lympho-Venous 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 by approximately 50% but does not eliminate the risk.
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 lipofobrosis 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.
Our state-of-the-art multidisciplinary breast cancer clinic provides world-class evaluation and care for patients with diagnosed breast malignancies. This unique setting brings together physicians from multiple specialties to provide the full range of medical and surgical therapies in a one-stop location for breast cancer care.
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
Ductal carcinoma is the most common type of breast cancer. It begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Ductal carcinoma may be either ductal carcinoma in situ (DCIS) or invasive ductal carcinoma.
DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct and have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer. In invasive ductal carcinoma, cancer has spread outside the breast duct to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.
Symptoms
DCIS doesn't typically have any signs or symptoms. However, DCIS can sometimes cause signs such as a breast lump or bloody nipple discharge. DCIS is usually found on a mammogram and appears as small clusters of calcifications that have irregular shapes and sizes.
Invasive ductal carcinoma may not cause any symptoms at first. Often, an abnormal area turns up on a screening mammogram. In some cases, the first sign of invasive ductal carcinoma is a new lump or mass in the breast that you or your doctor can feel.
Any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive ductal carcinoma:
Risk Factors
Some risk factors that may increase your odds of developing ductal carcinoma include:
Lobular carcinoma is cancer that begins in the lobules (milk glands) of the breast. Lobular carcinoma may be either lobular carcinoma in situ (LCIS) or invasive lobular carcinoma. LCIS is a noninvasive condition in which abnormal cells are found in the lobules of the breast. LCIS is currently considered a high-risk lesion and having LCIS in one breast increases the risk of developing invasive cancer in either breast. In invasive lobular carcinoma, cancer has spread from the lobules to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.
Symptoms
At its earliest stages, invasive lobular carcinoma may cause no signs and symptoms.
As it grows larger, invasive lobular carcinoma may cause:
Invasive lobular carcinoma is less likely than other forms of breast cancer to cause a firm or distinct breast lump.
Risk Factors
If you've been diagnosed with LCIS — abnormal cells confined within breast lobules — your risk of developing invasive cancer in either breast is increased. LCIS isn't cancer but is an indication of increased risk of breast cancer of any type. Most cases of LCIS occur before menopause.
Other risk factors for developing invasive lobular carcinoma include:
Mucinous carcinoma of the breast — sometimes called colloid carcinoma — is a rare form of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it into nearby healthy tissue). In this type of cancer, the tumor is made up of abnormal cells that “float” in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus.
Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver and other vital organs. Many types of cancer cells — including most breast cancer cells — produce some mucus. In mucinous carcinoma, however, mucin becomes part of the tumor and surrounds the breast cancer cells. Under a microscope, it looks like the cancer cells are scattered throughout pools of mucus.
Research suggests that only about 2 to 3% of invasive breast cancers are “pure” mucinous carcinomas — meaning that this is the only type of cancer present within the tumor. Mucinous tumor cells tend to behave less aggressively than more typical kinds of invasive ductal cancer. About 5% of invasive breast cancers appear to have a mucinous component within them, with other types of cancer cells present as well. Mucinous carcinoma is extremely rare in men.
Symptoms
Like other types of breast cancer, mucinous carcinoma of the breast may not cause any symptoms at first. Over time, a lump may grow large enough to be felt during breast self-exam or examination by a doctor. As with the other less common types of breast cancer, diagnosing mucinous carcinoma takes special skill and may be detected by mammogram, ultrasound, magnetic resonance imaging (MRI) or biopsy.
Risk Factors
Although mucinous carcinoma can be diagnosed at any age, it tends to affect women after they’ve gone through menopause. Some studies have found that the average age at diagnosis is in the 60s or early 70s.
Medullary carcinoma of the breast is a rare subtype of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it), accounting for about 3 to 5% of all cases of breast cancer. It is called “medullary” carcinoma because the tumor is a soft, fleshy mass that resembles a part of the brain called the medulla.
Medullary carcinoma cells are usually high-grade in their appearance and low-grade in their behavior. In other words, they look like aggressive, highly abnormal cancer cells, but they don’t act like them. Medullary carcinoma doesn’t grow quickly and usually doesn’t spread outside the breast to the lymph nodes. For this reason, it’s typically easier to treat than other types of breast cancer.
Symptoms
Like other types of breast cancer, medullary carcinoma may not cause any symptoms at first. Over time, a lump can form, and it may be soft and fleshy or somewhat firm to the touch. Most medullary carcinomas are small — less than two centimeters in size. Medullary carcinoma also may cause pain, swelling, redness, or tenderness in the breast.
Risk Factors
Medullary carcinoma can occur at any age, but it usually affects women in their late 40s and early 50s. Medullary carcinoma is more common in women who have a BRCA1 mutation. Studies have shown that medullary carcinoma is also more common in Japan than in the United States.
Metaplastic is a general term used to describe cancer that begins in cells that have changed into another cell type. In some cases, metaplastic changes alone may mean there is an increased chance of cancer developing at the site.
Metaplastic carcinoma of the breast is a rare form of breast cancer. The tumor cells differ in type from that of the typical ductal or lobular breast cancers. The cells look like skin cells or cells that make bone.
Symptoms
Some women experience no early signs or symptoms, while others experience general symptoms of breast cancers, such as new breast lumps.
General breast cancer symptoms include:
Risk Factors
Since this type of breast cancer is extremely rare, data on risk factors is limited. Advanced age, family history and inherited changes in the BRCA1 or BRCA2 genes are common overarching causes for most types of breast cancer.
Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or inflamed.
Inflammatory breast cancer is rare, accounting for 1 to 5% of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.
Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage III or IV, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.
Symptoms
Symptoms of inflammatory breast cancer include swelling (edema) and redness (erythema) that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange (called peau d'orange). These symptoms are caused by the buildup of fluid (lymph) in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.
Other symptoms of inflammatory breast cancer include a rapid increase in breast size; sensations of heaviness, burning or tenderness in the breast; or a nipple that is inverted (facing inward). Swollen lymph nodes may also be present under the arm, near the collarbone or both.
It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.
Risk Factors
Compared with other types of breast cancer, inflammatory breast cancer tends to be diagnosed at younger ages. It is also more common and diagnosed at younger ages in African American women than in white women, and risk increases if women are obese.
Like other types of breast cancer, inflammatory breast cancer can occur in men, but usually at an older age than in women.
There’s power in numbers. As one of the largest providers of cancer care in Florida, every one of our seven dedicated Central Florida locations and imaging facilities contributes to the strength of the AdventHealth network. Feel secure knowing that you have a widely connected team working together across exceptional facilities.
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You’ll feel even stronger when you’re surrounded by a loving support system. From our pampering Eden Spa and Boutique, which provides mastectomy bra fittings and wig fittings for breast cancer patients, to financial assistance tools, we’re here with the practical, emotional, and spiritual guidance you need.
Learn MorePrevention puts your wellness in your own hands. We built our Breast Health Center to help empower you. Our mission is to help you identify your risk of breast cancer, through both genetic and non-genetic factors. No matter your age or stage, a team of nurse practitioners and genetic counselors is available to guide you, help you evaluate your cancer risks and recommend a personalized screening plan or preventive treatments.
Our cancer specialists and researchers are continuously discovering new ways to prevent and treat cancer. We participate in more than 175 national clinical trials a year. This gives you access to many of the latest treatments and prevention methods, many of which may not be widely available for months, or years, to come.
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It’s always a good idea to get a second opinion. Our second-opinion experts can serve as a fresh pair of eyes, helping bring clarity and certainty to you and your family.
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Our breast cancer patients often find comfort and hope where they least expect it: in the company of people who end up becoming part of your support system. Connect with patients, survivors, and a compassionate support group staff who truly understand what you’re going through.
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New studies. New research. New technology and more. We’ll keep you informed of innovative treatments, advanced techniques, and the latest offerings at AdventHealth Cancer Institute.
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Find healing, find community, and stay in the know. With a wide variety of events year-round, we’ll help you connect with other patients, caregivers, support groups, as well as our compassionate care team.
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