Inclusion Criteria:

        The patient must have signed and dated an IRB-approved consent form that conforms to
        federal and institutional guidelines.

          -  Female

          -  18 years or older

          -  ECOG performance status of 0 or 1

          -  Eligible tumors must meet one of the following criteria:

               -  Operable (T1c, T2-3, N0-1, M0)

               -  Locally advanced (T2-3, N2-3, M0 or T4a-c, any N, M0)

               -  Inflammatory breast cancer (T4d, any N, M0)

          -  Staging evaluation:

               -  History and physical exam, cbc, chemistry profile

               -  CT Chest/Abdomen/Pelvis and a bone scan or PET/CT as needed

          -  Diagnosis of invasive adenocarcinoma made by core needle biopsy

          -  Breast cancer determined to be:

          -  Confirmed HER2-positive : (ASCO CAP guidelines, 10/7/2013)

               -  IHC 3+ based on circumferential membrane staining that is complete, intense

               -  ISH positive based on:

               -  Single probe average HER2 copy number ≥ 6 signals/cell

               -  Dual probe HER2/CEP 17 ratio ≥ 2.0 with an average HER2 copy number ≥ 4.0
                  signals/cell

               -  Dual probe HER2/CEP 17 ratio ≥ 2.0, with an average HER2 copy number of < 4.0
                  signals/cell

               -  Dual probe HER2/CEP 17 ratio < 2.0 with the average HER2 copy number of ≥ 6.0
                  signals/cell

          -  any ER or PR receptor status

          -  LVEF assessment by echocardiogram within 30 days of initiation; EF of ≥ 55% considered
             normal.

          -  Normal troponin I level at baseline

          -  Blood counts must meet the following criteria:

               -  ANC greater than or equal to 1500/mm3

               -  Platelet count greater than or equal to 100,000/mm3

               -  Hemoglobin greater than or equal to 10 g/dL

          -  Serum creatinine less than or equal 2.5 mg/100ml

          -  Adequate hepatic function by these criteria: total bilirubin must be less than or
             equal to 1.5 x the ULN for the lab unless the patient has a bilirubin elevation great
             than the ULN to 1.5 x ULN due to Gilbert's disease or similar syndrome involving slow
             conjugation of bilirubin; and alkaline phosphatase must be less than or equal to 2.5 x
             ULN for the lab; and AST must be less than or equal to 1.5 x ULN for the lab. Both
             alkaline phosphatase and AST may not both be greater than the ULN.

          -  Patients with AST or alkaline phosphatase > ULN are eligible for inclusion in the
             study if liver imaging (CT, MRI, PET-CT or PET scan) performed within 90 days prior to
             randomization does not demonstrate metastatic disease and the requirements are met as
             above

          -  Patients with alkaline phosphatase that is > ULN but less than or equal to 2.5 x ULN
             or unexplained bone pain are eligible for inclusion in the study if a bone scan,
             PET-CT scan, or PET scan performed within 90 days prior to randomization does not
             demonstrate metastatic disease.

        Exclusion Criteria:

        Patients with a history of decompensated congestive heart failure or an EF < 55% will be
        excluded

        • Cardiac disease that would preclude the use of the drugs included in the above regimens.
        This includes but is not confined to:

          -  Active cardiac disease:

          -  angina pectoris requiring the use of anti-anginal medication;

          -  ventricular arrhythmias except for benign premature ventricular contractions
             controlled by medication;

          -  conduction abnormality requiring a pacemaker;

          -  supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with
             medication; and

          -  clinically significant valvular disease

          -  symptomatic pericarditis

          -  pulmonary hypertension

          -  History of cardiac disease:

          -  myocardial infarction;

          -  congestive heart failure; or

          -  cardiomyopathy