Does my bathroom addition require breaking the concrete?

I'm planning on calling a plumber to give me an estimate on my bathroom addition. There is no basement, it is on the first floor on a concrete slab.

I already have a bathroom on the 2-nd floor right above. The cast iron vent pipe is going down through the existing bathroom and I'd like to connect the new toilet, sink to it. I'm also hoping for a shower too but if the breaking concrete will be required I might opt out.

Is breaking the concrete inevitable? I was hoping maybe the horizontal toilet could still be able to be attached at the bottom. Not sure about the shower as the piping will require a slope.
#Plumbing #Concrete #Bathroom