Breast cancer care continues to evolve through thoughtful innovation

ALTAMONTE SPRINGS, Fla. - During Breast Cancer Awareness Month, Devina McCray, MD, reflects on how advances in breast cancer surgery are creating more individualized options for patients.

As a breast surgeon at AdventHealth, Dr. McCray cares for patients with breast cancer, high-risk conditions and complex breast concerns.

She was recently selected as one of the first 15 breast surgeons nationwide to receive specialized training in robotic nipple-sparing mastectomy, an emerging approach that may offer appropriately selected patients with additional options for treatment and reconstruction.

Q: What does being selected for this specialized training mean to you?

A: I am grateful that AdventHealth is supporting my training and the collaboration and infrastructure needed to bring this option to those we care for in Central Florida - it is an extraordinary honor and a tremendous responsibility.

This is a new surgical platform, so being part of this first group is not simply about being among the first to use new technology. It is about introducing the approach thoughtfully and safely, helping establish responsible patient selection criteria, developing effective surgical workflows and ensuring that innovation translates into meaningful value for patients.

Q: What is robotic nipple-sparing mastectomy?

A: A nipple-sparing mastectomy removes the breast tissue while preserving the breast skin envelope and nipple-areolar complex as long as doing so is oncologically appropriate.

With the robotic approach, the surgeon controls the instruments from a console while using a magnified, three-dimensional view and wristed instruments to work through a limited-access incision, usually about three centimeters, toward the side of the breast.

Like other robotic procedures we do at AdventHealth, the robot does not perform the operation independently. Every movement is controlled by the surgeon, who remains in the operating room.

The innovation is in the method of access and visualization while the objective remains the same: removing the appropriate breast tissue and keeping patient safety as the priority.

Q: What potential benefits could this approach offer patients?

A: One potential benefit is placing the incision away from a more visible part of the breast, which may allow for a more favorable cosmetic result.

The system also enhances visualization and helps the surgeon maneuver in areas that can be difficult to reach through a small incision.

Because the incision is smaller and fewer peripheral nerves may be affected, some surgeons are seeing patients regain sensation.

Robotic surgery is not automatically better for every patient, and it does not eliminate the risks associated with mastectomy or reconstruction. Patients must be selected individually, and the procedure is never chosen at the expense of safety.

Q: How has breast cancer surgery evolved in recent years?

A: Breast cancer surgery has become increasingly individualized. We have moved away from the idea that more extensive surgery is always better. Today, the goal is to perform the least invasive operation that still provides appropriate cancer treatment and control.

Innovations include improved breast-conserving and oncoplastic techniques, expanded use of nipple-sparing mastectomy, more targeted lymph node surgery, improved lesion localization, single-stage reconstruction and nerve preservation techniques that may help patients regain sensation.

Robotic-assisted surgery is another step in this evolution. We continue to focus on treating the cancer while also paying closer attention to function, sensation, appearance, recovery and the patient's experience throughout survivorship.

Q: Is there a broader story behind this innovation?

A: Leadership in medicine is not simply about acquiring technology. It means developing a carefully governed program, providing specialized training, measuring outcomes, selecting patients responsibly, and creating a safe, coordinated experience from consultation through recovery and survivorship.

This initiative reflects AdventHealth's commitment to bringing carefully evaluated advances to patients in Central Florida. It also demonstrates how innovation can support a broader vision of cancer care, one that treats the disease while recognizing the patient as a whole person: long-term quality of life, body image and personal priorities.

Q: What are you most looking forward to?

A: I am excited to offer another option to patients who are appropriate candidates.

Mastectomy can be physically and emotionally significant. I often tell my patients, "I want you to be able to look in the mirror and not always be reminded of what you went through."

I am hopeful this approach will help patients feel more comfortable in their bodies after surgery. I am also looking forward to building this program with my multidisciplinary team, studying outcomes and contributing to the continued evolution of breast cancer care.