Groundbreaking Surgery Reverses the Effects of Lymphedema Caused by Breast Cancer Treatment

India Robinson had her first mammogram in August 2022. She was 40 years old.

“I’d waited a while due to the pandemic. Plus, I’d breastfed my children, and had no family history of breast cancer, so I figured I’d get to it when I got to it,” says India. “When my OB/GYN said I needed to have one, I went.”

Almost immediately, India received a call back. New images were needed. She thought that was a bit weird but scheduled another. That mammogram showed some calcifications and something else. India was immediately sent for an ultrasound. Following that, doctors said she needed a biopsy, and soon.

Two weeks later, two different biopsies were done. The next day – October 25, her birthday – India received a call. “The one area biopsied was malignant, meaning cancer. With those words, my whole world turned upside down,” India recalls.

Within two days, India, her fiancé (they married during the course of her treatment), her mom and her sister were at Cleveland Clinic Taussig Cancer Center, meeting with various doctors to discuss genetic testing, radiation oncology, hematology, breast cancer surgery and more. Additional testing to pinpoint the type of cancer – diagnosed as Stage II breast cancer – took place prior to the start of treatment.

On November 15, India had surgery. “I was happy to have the cancer out of my body, and know there were clear margins,” she says.

Chemotherapy began on December 12. Throughout treatment, India had many negative side effects including sores in her mouth and loss of her hair. Radiation treatment caused second-degree burns. “There were other women in treatment at the same time as me, some of whom had virtually no side effects, while I was unrecognizable even to myself,” she says.

With treatment complete in March, India thought she was through the hardest part. But later that month, her right arm felt heavy. At an occupational therapy session that was part of her recovery program, when the therapist massaged her arm, her breast immediately swelled up. If the breast was massaged, her arm swelled up.

“I was seeing her twice a week, trying to work things out, but nothing really helped. The therapist told me about a surgeon, Graham Schwarz, MD, whom she’d heard was using some unique techniques,” says India. Shortly thereafter, Vincent Wu, MD, India’s Cleveland Clinic breast cancer surgeon, referred her to Dr. Schwarz, who is Vice Chair of the Department of Plastic Surgery at Cleveland Clinic and Director of the Microsurgery Fellowship Program.

Lymphedema, a buildup of fluid caused by the removal of lymph nodes from the armpit during breast cancer surgery and sometimes by scarring caused from radiation, was causing the significant swelling and pain in India’s right breast.

“While India had gone through the excellent breast rehabilitation therapy program at Cleveland Clinic, and traditional lymphedema treatment with compression garments, massage and exercise, she needed a little something extra,” says Dr. Schwarz.

In July 2024, two years after beginning her breast cancer journey, India became the first patient in the United States to undergo robotically assisted lymphatic microsurgery, thanks to Dr. Schwarz and the Symani® Surgical System – a first-of-its-kind robotic technology that had recently been acquired by Cleveland Clinic.

“The armpit area functions like an intersection of fluid drainage pathways between the arm and the breast. When lymph nodes are removed, some of the pathways are cut, which can lead to the accumulation of fluid. Most commonly this swelling occurs in the arm, but in India’s case, the fluid became trapped in her breast,” explains Dr. Schwarz. “We often have success treating cancer-related lymphedema of the arm with surgery that involves the creation of bypasses to reroute the lymph fluid into the bloodstream. This isn’t a problem I see nearly as often in the breast, but I thought we could help India by performing this specialized procedure in certain areas of her affected breast.”

“I’m no longer suffering from lymphedema. I’ve been able to return to work, return to the gym, return to life!”

A pre-diagnostic test using fluorescent dye injected into the breast area to create a map of the lymphatic system showed there were, in fact, areas of blockage that would likely be resolved.

The groundbreaking outpatient surgery that included the use of a robot to increase precision due to the size of the vessels – some less than half a millimeter in size – took just a few hours. Tiny incisions made right under the surface of the skin meant India went home the same day, with instructions to take Tylenol for pain.

India had a dramatic response. While the effects of the radiation to her breast are still there, she had significant improvement of the lymphedema almost immediately.

“The swelling was about 70% less within 24 hours, and it’s completely gone now,” says India. “I’m no longer suffering from lymphedema. I’ve been able to return to work, return to the gym, return to life!”