UI Biomedical Engineering Students Tackle Lymphedema in Breast Cancer Patients

By Lynn Anderson Davy
University of Iowa Strategic Communication

When biomedical engineering students Genevieve Goelz, Maria Fernanda Larraga Martinez, Anna Rodriguez, and Ashten Sherman teamed up for their senior design course in September 2017 to find a solution to lymphedema in breast cancer patients, they didn’t know a lot about each other or the medical condition they were tapped to study.

But in the eight months since accepting the challenge to create a garment to prevent lymphedema, painful swelling that can occur in the arms or torso after mastectomy surgery, the young women have learned to trust each other. They have sought input from medical experts, breast cancer patients, physical therapists, and engineering professors. And they have shared personal victories and heartbreak.

Every year, biomedical engineering students take on an “unmet need” and spend a year designing and testing   a solution that may be in the form of a prototype or software program.  (You can submit an idea for the 2018/19 biomedical engineering senior design course via this online form--https://uiowa.qualtrics.com/jfe/form/SV_3z0qSux6AV1DiYd.)

“Everyone knew each other’s faces before, but not all of us were friends,” says Goelz, a biomedical engineering major and math minor from Algonquin, Illinois. “Since we started the project, we have developed a great team bond. We even designed our own team sweatshirts.”

The camaraderie between the young women, or Team 15 for the purpose of the senior design course, grew during group meetings in the University of Iowa College of Engineering Student Commons and during evenings spent poring over design journals, prototype mockups, and a plastic mannequin named Jess, the team’s model and mascot.

And while much of their time together focused on work, they also enjoyed moments of pure fun, like when the team shared laughs over hamburgers at McDonald’s after a visit to a mastectomy fitter, or when they used bolt cutters to shear off one of their mannequin’s plastic breasts to mimic a unilateral mastectomy.

“Working with these women has been one of the best experiences of my undergrad career,” says Ashten Sherman, a biomedical engineering major and psychology minor from LeClaire, Iowa. “I feel so blessed to call them friends.”

The senior design project: A long-haul mental challenge

The senior design project is meant to be challenging. It’s a year-long course that represents the culmination of four years of engineering training. The course syllabus includes numerous requirements (six design review meetings; two to four design journal entries per week); as well as warnings about “blank looks” (“in real life this puts you at the top of the list to be fired/replaced/outsourced”), meetings with mentors (“do not wait for instructors to tell you to meet with your mentor”), and common pitfalls (“don’t assume everything will be perfect”).

The course seeks to emulate the real-world product development process, including the challenges that come with it. In small teams of three or four members, students work with a mentor to prototype a medical device that addresses a real-life need or problem. At the final senior design presentation, teams demonstrate their device and discuss its benefits before a jury of experts and a lecture hall of family and friends. Mentors—people who submit ideas for the course—often are in attendance.

Watch the video by Matt Jansen https://www.youtube.com/watch?time_continue=7&v=JdmpTdyeGGc

Students must complete the course to graduate, but because of its all-encompassing nature, many view it as a final stamp of approval before they enter the workforce or graduate school. This perception adds another layer of pressure, and successful teams usually go above and beyond the work outlined in the course syllabus.

“Students who tend to excel in this real-world environment are those who take the initiative to start physical prototyping early on in the project and who follow sound engineering principles,” says Colleen Bringman, a lecturer and one of four engineering professors who oversees the senior design course in biomedical engineering.

Step 1: Identify a need

The idea for Team 15’s senior design project came from Amy Kimball, an associate in the Department of Physical Therapy and Rehabilitation Sciences, part of the UI Roy J. and Lucille A. Carver College of Medicine. Kimball works with breast cancer patients in the period immediately after their mastectomy surgery and knows how vulnerable they can be to lymphedema, a condition that can affect the arms and torso. If left untreated, the condition can lead to loss of function and physical disfigurement.

Although many patients with breast cancer have both breasts removed, a procedure called a bilateral mastectomy, some (roughly 32,000 annually, according to BreastCancer.org) opt for a unilateral mastectomy so they can keep their healthy breast. The medical device industry has been slow to devise viable post-operative solutions for this group of patients, and in some cases, physical therapists improvise by stuffing a bra with dense foam to put pressure on the mastectomy side, which reduces swelling.

“When I was a practicing physical therapist, I would see patients who could not find a garment that would provide them with the compression they needed on one side of the chest and the support they needed on the other,” Kimball, who is pursuing a doctoral degree at the UI, says. “Many of these patients are left in a sort of uncomfortable limbo. A solution to this problem has the potential to impact thousands of breast cancer patients.”

Kimball says she was excited about the prospect of working with biomedical engineering students to help address the issue.

“It’s been fun to work with young women who are aspiring engineers and scientists,” says Kimball, who met with the team throughout the year-long process. “When I brought the problem to the table, they didn’t know much about the health care side of it, so I told them what breast cancer patients go through, and then the problem became very real to them. They have really run with this project, and they have taken a very personal approach to their engineering design because they see it as a product that could help real people.”

Step 2: Find a solution

Team 15 started work on the project by meeting with the people most likely to be affected by truncal lymphedema: breast cancer patients.

All four women on the team knew someone with breast cancer, but Goelz had the closest connection: her 78-year-old grandmother, Geri Goelz, died in February after a third reoccurrence. Goelz took time to grieve for her grandmother but didn’t let her grief overcome her. She returned to work on the GAMA bra immediately after her grandmother’s funeral, spurred in part by her grandmother’s interest in the project.

When the team started to investigate the problems that breast cancer patients encounter after a mastectomy, it was Geri Goelz who walked them through the surgeries and drug treatments, the insurance hassles, and prosthetic breast fittings. From the comfort of her recliner at her home in Elmhurst, Illinois, Geri Goelz helped the young women on the other end of the telephone line understand the mental and physical trauma she endured. Her honesty and sense of humor impressed everyone.

“It actually helped that I was working on this project at the time of her death,” says Goelz. “It reminded me of why I got into engineering in the first place. As biomedical engineers, we’re creating solutions for people who are facing life-and-death situations. I don’t think there’s a better way that I could be honoring my grandmother’s memory.”

Besides Goelz’s grandmother, Team 15 also interviewed physical therapists, oncologists, and plastic surgeons. They also began thinking about the amount of compression that would be needed to prevent swelling and the types of materials that could provide it. In their design journals, the women made extensive notes about the compression attributes of rayon, nylon, and spandex, and drew rough sketches of different garment models. Would their garment be more like a bra or a vest? How large should the arm holes be? What would be easier for patients, a zipper or Velcro closure?

“The biggest challenge with the garment was just being able to put everything that we needed to consider together in one prototype,” says Rodriguez, a biomedical engineering and pre-medicine major from Bettendorf, Iowa. “We had a lot of problems determining which material would be best, and then also keeping in mind the comfort of the patient and the design of the garment in terms of aesthetics because we want people to wear it, and they won’t if it looks clunky under a T-shirt.”

During the invention phase of the project, biomedical engineering students do a lot of tests to ensure their prototype will be viable. Team 15 measured the material properties of different fabric samples. Using a wood clamp and a paper grid, they measured how the samples stretched and how their shape changed as the fabric pulled. They wanted to be sure that the fabric they selected for their garment would be tight enough to provide the right amount of pressure, but not so tight that it cut off circulation or restricted breathing.

Another challenge of the project is thinking outside the box. For example, when the members of Team 15 realized that they weren’t good enough seamstresses to sew the final lymphedema prototype themselves, they sought the help of costume designers in the UI Department of Theatre Arts. When they found out that compression garment companies wouldn’t donate bolts of fabric due to possible patent infringement, they bought extra-long compression socks and cut them down to size.

Another unexpected challenge was dealing with naysayers.

“In any journey toward a solution, you will have people who don’t believe in the problem you are trying to solve,” says Sherman. “Working through the negative comments and dismissals was tough, but we knew that we were doing something positive that would impact a whole community of patients, and that kept us going.”

Step 3: Eureka!

At the senior design presentation, Team 15 presented the third and final prototype of its lymphedema garment, called the GAMA bra, an acronym that includes the first letter of each of their first names. During their presentation, the women discussed the steps they took to prove the effectiveness of their prototype and described the educational pamphlet and mock website they created to educate breast cancer patients about the risks of truncal lymphedema after mastectomy surgery.

And while they have learned a lot about biomedical engineering and the long road from problem to solution, they say the biggest changes they have noticed in themselves and each other have little to do with technology or academics. All four women say the senior design experience has reassured them that they are on the right track in their lives and careers, and the project has provided them with a better sense of self. 

“Since both of my parents are engineers and there are a lot of engineers in my family, I always knew that I would go into engineering,” says Martinez, a biomedical engineering major with a minor in math from Monroe, Wisconsin. “But this project has taught me a lot about independence and making decisions on my own. Although we had some guidance, it was really up to us to decide what tests to do and how to set our timeline.”

Kimball, the team’s mentor, has also noticed these changes.

“I can confidently say that these young women are thinking in a totally different way,” she says. “It’s inspiring to see what they have accomplished, how they have managed to bridge the gap between classroom learning and real-world problem-solving. As a professor, I can’t think of a better way for a student to grow.”

After the stress of senior design day and the emotional rush of their graduation ceremony have faded, Team 15 will move on to new challenges. Rodriguez and Sherman will attend medical school, and Martinez will begin a graduate program in prosthetics and orthotics. Goelz says she will take a year off from school to work, and then probably pursue a graduate degree in biomedical engineering.  

As they prepare to go their separate ways, the young women have vowed to keep in touch and to continue working on their GAMA bra. They may pursue a patent, but are still considering next steps.

“In terms of the journey, I’d say we’ve really come a long way,” says Rodriguez. “I mean, this is kind of where I expected to be, but at the same time it’s not at all where I expected to be, if that makes sense? We’ve kind of had to come into our own and figure it all out. It’s crazy to look back and see our notes and realize how little we knew.”

As part of their senior design course, biomedical engineering students (from left) Anna Rodriguez, Maria Fernanda Larraga Martinez, Ashten Sherman, and Genevieve Goelz created the GAMA bra, a compression garment that can be worn by breast cancer patients after a unilateral mastectomy. The garment could help thousands of patients avoid painful swelling associated with lymphedema. Here, the team uses a filler substance to help give their modified mannequin a more lifelike feel in terms of weight and rigidity. Photo by Tim Schoon.