不化妝就兩眼無神，眼妝常被下垂的眼皮吃掉嗎？創新「眼型美學」整體治療技術 ，不必再靠「夾睫毛」和「雙眼皮貼」，自然隱痕雙眼皮重啟術，同時美化眼型+改善視線，由院長親自手術，解決你的所有眼型問題 量身定做 雙眼皮美型手術 Eye shape aesthetic treatment 由前林口長庚醫院院長 鄭明輝教授率領業界名醫 主任醫師 張豫苓 韓式眼袋打勾手術、鼻整形手術、脂肪移植、內視鏡拉皮手術、輪廓埋線拉提手術、微整型針劑注射 身材雕塑：抽脂雕塑 ◎ 門診時間：隔週三 下午12:00-15:00 LEARN MORE 主任醫師 杜隆成 顏面、眼部整形：雙眼皮進化式縫法、內開上眼瞼下垂手術、內開下眼袋整形手術、顏面脂肪移植年輕化手術 身體雕塑：乳房脂肪移植整形手術、男性女乳症手術、腹部鬆弛整形手術 ◎ 門診時間：每週一 下午14:00-17:00 LEARN MORE 美麗見證 我想變成雙眼皮、看起來更有精神，該怎麼和醫師討論? 雙眼皮的形成，主要是因為「上瞼組織內的提上眼瞼肌纖維｣附著於眼皮上，當我們睜眼時，上方的皮膚會懸垂於前，互相折疊，使得摺線明顯，看起來就形成雙眼皮的樣子。單眼皮的人若要透過人為方式，製造這條雙眼皮摺線時，雙眼皮的呈現效果，並不是完全決定於醫師設計的寬度有多少，還需要考量醫師設計的寬度被上眼皮覆蓋之後，真正「露出的寬度有多少｣，進行精確的預判和調整。 以下困擾都能改善： 1.天生單眼皮 2.內雙 3.眼皮不對稱（大小眼） 4.眼睫毛倒插 5.眼皮浮腫(眼窩脂肪多) 6.眼皮鬆弛 7.雙眼皮過寬、過窄、眼裂長 8.摺線不明顯(眼窩脂肪少) 9.多層摺痕眼皮 10.眼皮覆蓋影響視線 11.眼尾下垂影響視線 眼皮類型及適合做的手術： 1.天生單眼皮 2.內雙 3.眼皮不對稱（大小眼） 4.眼睫毛倒插 5.眼皮浮腫(眼窩脂肪多) 6.眼皮鬆弛 7.雙眼皮過寬、過窄、眼裂長 8.摺線不明顯(眼窩脂肪少) 9.多層摺痕眼皮 10.眼皮覆蓋影響視線 11.眼尾下垂影響視線

瞭解更多顯微淋巴結皮瓣移植的適合對象、手術結果、術前及術後的對比和分析，全部來自於鄭明輝教授的多年經驗。 Vascularized Lymph Node Flap Transfer (VLNT) Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery About VLNT Lymphedema can cause painful and unsightly swelling in the arms and/or legs. Though there are varying degrees of lymphedema, Dr. Cheng’s expert microsurgery techniques provide several possible solutions. For patients with Cheng’s Lymphedema late Grade II to Grade IV, and no clear functioning lymphatics shown on indocyanine green (ICG) lymphography images, a vascularized lymph node (VLN) flap transfer is recommended. For patients with more severe cases of lymphedema, such as lymphedema Grade IV, there may be a need for a liposuction or a partial wedge excision one year after the VLN flap transfer. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Case Before Surgery: This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. After Surgery: At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. Before Surgery: A 53-year-old patient with grade II breast cancer-related lymphedema of the right upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. Before Surgery: A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively. Before Surgery: A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At the 50-months follow-up, the reduction rate was 80% above the elbow and 45% below the elbow without the use of a compression garment. Candidates for VLN Flap Transfer Lymphedema patients who aggressively received rehabilitation for more than 6 months without making any improvement. Patients that develop episodes of cellulitis. Patients with total lymphatic obstruction present in diagnostic imaging (lymphoscintigraphy). Patients with no patent lymphatic (collecting) ducts available for the procedure of lymphovenous anastomosis (LVA). (See LVA section) Patitents with Cheng’s Grading Ⅱ, Ⅲ and Ⅳ lymphedema How Does It Work? The choice of the donor site for the VLN flap surgery is based on patient preference, and the availability of sizable lymph nodes at the preferred site. Before the donor site is chosen, Dr. Cheng uses ultrasound images to determine the viability of the lymph nodes. Given these factors, the vascularized submental lymph node (VSLN) flap is the most commonly preferred VLN flap by Dr. Cheng’s patients. Usually, the VSLN flap is transferred to the back of the wrist or to the ankle in accordance with the “pump” mechanism, catchment effect, and natural gravity effect to achieve maximal functional recovery. Though this surgery can provide great relief for painful swelling, the unsightly skin on the wrist may be bothersome to the patient. Fortunately, one-year after VSLN flap transfer surgery it can be removed, leaving a more subtle, linear scar. At this point, the limb previously affected by the lymphedema should be softer and smaller as well. Intrinsic lymphovenous connections exist within the lymph node flap. These connections are responsible for shunting the lymphatic fluid into the venous system, creating local decompression at the site of vascularized lymph node flap transfer. 資料來源： 淋巴水腫手術的原則和實踐。 Cheng MH，Chang DW，Patel KM（編輯）。 Elsevier Inc，英國牛津。 ISBN：978-0-323-29897-1。 2015年7月，第65頁。 此圖右側肢體正常，左側為上肢及下肢淋巴水腫。 可使用的治療方法如：淋巴管靜脈吻合術或顯微淋巴結皮瓣移植。 資料來源： 淋巴水腫手術的原則與實踐。 Cheng MH，Chang DW，Patel KM（編輯）。 Elsevier Inc，英國牛津。 ISBN：978-0-323-29897-1。 2015年7月，第219頁。 淋巴結供體區 1. 下領部 2. 鎖骨下 3. 胸椎 4. 腹股溝 5. 大網膜 6. 腸系膜 淋巴水腫的病理生理 a. 淋巴積聚 b. 炎症發炎 c. 脂肪增生 d.纖維化 淋巴結皮瓣接受區 I. 手腕（背部或手掌） II. 手肘 III. 腋下 IV. 腹股溝 V. 後腿近端 VI. 足踝（前側或内側） What to Expect After Flap Transfer Surgery Dr. Cheng’s unique surgical technique can greatly improve the quality of life of patients suffering from lymphedema. By transferring the vascularized lymph node flap to the recipient site, for example to the wrist, Dr. Cheng improves the functionality of the lymphatic system. As a result, the tissue becomes softer, the affected arms and/or legs become smaller and lighter and the patient experiences less cellulitis. This in turn gives the patient an improved cosmetic appearance. In addition, it is important to note that with Dr. Cheng’s superior technique and skills, patients no longer need to wear compression garments post-surgery. Although after VLN flap surgery the initial transferred flap on the wrist is not aesthetically pleasing, one year after the surgery the transferred skin may be removed. Typically done under local anesthesia, this procedure will leave the wrist with a subtle, linear scar instead. In Cheng’s experience, the success rate of the vascularized lymph node flap is 98%. With an average 18 months of follow-up after VLNT surgery, 90% of BCRL patients show substantial improvement, with an average circumferential difference improvement of 40%. Though patient results vary, in general, post-surgery the affected limb becomes much softer over time; and restriction of daily activities is minimized. After VLN flap surgery patients resume their normal life styles with a boost in self-confidence. A VLN Flap transfer with Dr. Cheng can alleviate lymphedema symptoms, greatly increasing patients’ quality of life. Evidences of Mechanism of Vascularized Lymph Node Transfer 1. Tc-99m Lymphoscintigraphy Increased Clearance on Static Images Static views of the same edematous upper limb on posterior view. Images of the upper extremity was taken at 30, 60 and 120 minutes after injection of radio-labelled tracer. Preoperative images (upper row: A-C) and postoperative images (lower row: D-F).In the pre-op images, there is prominent diffuse accumulation of activity shown in the skin of the affected forearm over time. Post-operatively, dermal backflow is less marked in the forearm (D-F) and the radio-labelled tracer has migrated more rapidly to the distal arm (arrow in F). Data source: Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75. 2. Vascularized Groin Lymph Node Transfer to Elbow of Post-op Lymphoscintigraphy A 68-year-old female patient who was a victim of right upper limb lymphedema underwent vascularized groin lymph node flap transfer to right elbow (A). Preoperative lymphoscintigraphy showed accumulation of Tc-99 in the forearm and absence of right axilla lymph node (B). At a follow-up of 56 months, the patient was satisfied with the softening of left upper limb with a circumferential reduction of 58% above elbow and 40% below elbow (C). Post-op lymphoscintigraphy revealed increased uptake of Tc-99 by the transferred vascularized lymph nodes at the elbow level and less accumulation of Tc-99 in right upper arm (D). Data source: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204-5. 3. Vascularized Submental Lymph Node Transfer to wrist of Post-op Lymphoscintigraphy A 52-year-old female patient who was a right upper limb lymphedema underwent vascularized submental lymph node flap transfer to right wrist. Pre-op lymphoscintigraphy showed accumulation of Tc-99 in the forearm and absence of right axilla lymph node. Post-op lymphoscintigraphy revealed increased uptake of Tc-99 by the transferred two vascularized lymph nodes at the wrist level and less accumulation of Tc-99 in right upper arm. Data source: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204-5. 4. Intra-op Image Evidences of Mechanism of Vascularized Lymph Node Transfer ICG Injection on Lymph Node Directly Native Lymph Drainage through VSLN Flap Data source: Proposed pathway and mechanism of vascularized lymph node flaps. Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. Gynecol Oncol. 2016 Apr;141(1):182-8. Q1 How can VLN surgery improve lymphedema? Lymphedema is caused by a blockage in the lymphatic system. If the lymph fluid is unable to circulate through the body, it builds-up and causes minor to severe swelling. Typically, lymphedema swelling is seen in the arms and/or the legs, though it can occur is other parts of the body. There are different degrees of lymphedema and some cases can be treated non-surgically. However, for certain types, such as Cheng's Grade II, III and IV lymphedema, surgery may be the only option to alleviate symptoms and reduce swelling. The VLN flap transfer unblocks the lymphatic system in order to allow the lymph fluid to circulate better, reducing swelling in the affected limb over time. Dr. Cheng has been extremely successful in using this technique to treat moderate to severe cases of lymphedema. Q2 Are follow-up appointments post-surgery required? VLN flap surgery with renowned surgeon Dr. Cheng has an excellent success rate. However, the VLN flap surgery is a delicate procedure that requires several follow up appointments after the surgery. These appointments allow Dr. Cheng to carefully measure the circumference of the affected limb or limbs to ensure optimal results. Dr. Cheng will discuss symptom relief with patients, which helps to determine the success of the transferred lymph nodes. Although no compression garments are needed, it is important to attend all follow-up appointments in order to assess progress anddetermine if any addition physical therapy is necessary. Q3 Why choose Dr. Cheng for VLN flap surgery? As an internationally renowned surgeon, Dr. Cheng is an expert in several microsurgery techniques that address lymphedema, including VLN flap surgery. With over a 98% success rate, Dr. Cheng can properly asses your condition and determine what is the best treatment plan. Depending on the grade of lymphedema, Dr. Cheng will recommend the best solution. As a plastic surgeon that specializes in reconstructive microsurgery, Dr. Cheng holds the world record for successfully treating the largest number of lymphedema patients with vascularized lymph node transfers. His unique technique and expert skill enable him to not only diagnose the cause and grade of lymphedema but also propose the best treatment to reduce patients' symptoms and improve their quality of life. Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

眼型美學療程 Eye shape aesthetic treatment 去眼袋明眸術：跟NG泡泡眼、下眼袋一起說掰掰~~ 卸除下眼袋、填平淚溝、消除黑眼圈、撫平眼下細紋，一次解決眼周全部問題！ 眼型美學療程 Eye shape aesthetic treatment 去眼袋明眸術：跟NG泡泡眼、下眼袋一起說掰掰~~ 卸除下眼袋、填平淚溝、消除黑眼圈、撫平眼下細紋， 一次解決眼周全部問題！ 眼袋是怎麼形成的？會自然消失嗎？ 我們的眼睛下方通常會有脂肪保護緩衝，而脂肪前還會有「眼眶隔膜」的筋膜及「眼輪匝肌」的肌肉構造，提供眼睛完整的保護力，正常情況下不會有眼袋問題。然而，當脂肪堆積太多、下眼瞼肌膚鬆弛，導致眼下的支撐力變弱，就容易使眼下產生鼓鼓、腫腫的眼袋。 從上述可知，眼袋屬於立體的構造，所以無論怎麼用化妝品遮擋，其實都很難蓋掉，反而更顯勞累和妝感重，與清透年輕的妝感背道而馳，這是許多「眼袋族」最大的困擾之一。此外，眼袋的另一個特徵是不笑時會變明顯，而當大笑時因臉部肌肉收縮，眼袋就會變小或消失。 三種常見的眼袋類型： 1.天生型眼袋 先天遺傳性形成的眼袋，常見像是眼眶脂肪過多，導致眼窩脂肪突出形成眼袋；另一種常見的天生型眼袋是因為眼輪匝肌天生發達，使肌肉會隨著面部動作變凸、變明顯，這類型的眼袋一般年輕時就會出現，難以透過日常保養改善。 2.暫時型眼袋 又被稱為「水腫型眼袋」或俗稱「泡泡眼」，主要是由於前一天熬夜、喝酒、大哭或攝取過多鹽分等因素，導致隔天起床眼袋容易浮腫，屬於假性眼袋，通常幾個小時後就會改善。 3.老化型眼袋 隨著年齡增長或長期過度用眼，眼下肌膚的膠原蛋白流失，使得眼下的支撐力變弱，眼周脂肪隨地心引力向下滑落，形成下垂、突起的眼袋，部分個案也會合併淚溝及黑眼圈問題。 眼袋手術後注意事項： 1.每日皆須清潔傷口並換藥，至少3次。 2.若出現眼睛乾澀或發癢，可適度使用眼藥水滋潤眼球。 3.術後保持頭高腳低以利消除腫脹瘀青，術後冰敷2天，後續溫敷，每次約15~20分鐘。 4.約術後5~7天方可拆線。 5.術後避免服用刺激性食物，如抽菸、喝酒，不利於傷口癒合。

瞭解更多顯微淋巴結皮瓣移植的適合對象、手術結果、術前及術後的對比和分析，全部來自於鄭明輝教授的多年經驗。 Gallery Treatment of Moderate to Severe Lymphede Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs Case 1 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. At 2- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 27% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 36% and 15% above and below the elbow, respectively. The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 and 27 months. At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 60% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 72- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 50% above and below the elbow, respectively. At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. Case 2 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 38% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 6- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 32% and 15% above and below the elbow, respectively. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 30% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 18- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 90% and 40% above and below the elbow, respectively. At 22- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 35% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. Case 3 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 21- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 70% and 30% above and below the elbow, respectively. At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively. Case 4 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 6-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 20% above the elbow and 15% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 24-months follow-up, the reduction rate was 60% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 33-months follow-up, the reduction rate was 50% above the elbow and 25% below the elbow without the use of a compression garment. Case 5 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 12 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 3-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 22% above the elbow and 25% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 6-months follow-up, the reduction rate was 35% above the elbow and 25% below the elbow without the use of a compression garment. At the 12-months follow-up, the reduction rate was 30% above the elbow and 20% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in the wrist and liposuction for the left upper medial arm 14 months after surgery. At the 24-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow without the use of a compression garment. At the 38-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow. The patient was satisfied with the functional and cosmetic outcomes and did not wear a compression garment. Case 6 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 51-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 6 months after mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. Case 7 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 18 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was received non-vascularized lymph node transfer by other doctor on left elbow, and refractory to conservative decongestive therapy. At the 3-months follow-up, the reduction rate was 10% above the elbow and 23% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 10-months follow-up, the reduction rate was 20% above the elbow and 30% below the elbow without the use of a compression garment. The skin paddle in the middle forearm was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At the 20-months follow-up, the reduction rate was 100% above the elbow and 42% below the elbow without the use of a compression garment. Case 8 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs This is a 46-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 2 years after mastectomy, axillary lymph node dissection, and radiotherapy. She developed one episode of cellulitis per year with the use of compression garments. At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 20% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 24- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 37% and 20% above and below the elbow, respectively. At 38- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 70- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 75% and 50% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs Case 1 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 65-year-old female with grade IV left lower limb lymphedema for 3 years after cervical cancer and radiation. At the 3 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 30% above the knee and 40% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 9 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 85% below the knee without the use of a compression garment. Case 2 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 67-year-old female with grade IV right lower limb lymphedema for 8 years after cervical cancer and radiation. She was refractory to conservative decongestive therapy. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 15% above the knee and 5% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 67 months of follow-up, after flap revision and right lower limb liposuction. The circumferential reduction rate was 62% above the knee and 50% below the knee without the use of a compression garment. Case 3 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 15-year-old patient with left lower limb congenital lymphedema for 2 years. At the 24 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. Case 4 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 5-year-old patient with right lower limb congenital lymphedema for 2 years. At the 15 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 20% above the knee and 15% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 13 months of follow-up, after flap revision. The circumferential reduction rate was 25% above the knee and 20% below the knee without the use of a compression garment. Case 5 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 40-year-old patient with left lower limb congenital lymphedema for 15 years. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 5% above the knee and 23% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision and left lower limb liposuction. The circumferential reduction rate was 55% above the knee and 56% below the knee without the use of a compression garment. Case 6 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 52-year-old female with grade II left lower limb lymphedema and grade I right lower limb lymphedema for 5 years after cervical cancer and radiation. At the 1 month of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 19 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment.

Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. International Fellows Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. MD Joseph H Dayan Fellowship: 2008-2009, Present position: Associate Professor at Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center MD, PhD, FACS Holger Engel Fellowship: 2008-2009, Present position: Professor at Division of Plastic Surgery, BG Trauma Center Ludwigshafen, Germany MD, PharmD Dung Nguyen Fellowship: 2010-2011, Present position: Associate Professor at Division of Plastic Surgery, Stanford University Medical Center MD Wei Fen Chen Fellowship: 2010-2011, Present position: Professor at Division of Plastic Surgery, Cleveland Clinic MD Dhruv Singhal Fellowship: 2011-2012, Present position: Assistant Professor at Division of Plastic Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School MD, MBA John Chieh-Han Tzou Fellowship: 2012-2013, Present position: Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Ketan M. Patel Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, University of Southern California MD Shan Shan Qiu Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, Maastricht University Medical Center, the Netherlands MD, FRCSC Hattan Aljaaly Fellowship: 2014-2015, Present position: Assistant Professor at Division of Plastic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia MD, MS, FRCSC Olivia Ho Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, Mayo Clinic MD, MSc Marco Pappalardo Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, University of Palermo, Italy MD, FRCSC Arash Izadpanah Fellowship: 2017-2018, Present position: Assistant Professor at Division of Plastic Surgery, University of Manitoba MD Ines Tinhofer Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Satomi Koide Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, St. Vincent Hospital, Australia MD Chrisovalantis Lakhian Fellowship: 2019-2020, Present position: Assistant Professor at Division of Plastic Surgery, Georgetown University Medical Center MD Onur Aksoy Fellowship: 2023-2024, Present position: Prof Dr Cemil Tascioglu City Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey

案例分享：隆乳 + 縮乳頭 ｜「胸部不腫、不痛，也有下降，感覺更自然。胸型好了，連乳頭也一起變得更美，身材好了，穿衣服更好看。」 美麗見證 2024.4.18 手術 案例分享：隆乳 + 縮乳頭 從小就是個小胸人一直到懷孕哺乳，才體會到什麼叫胸🤣。 產後為了減肥，把剩餘僅存的胸（脂肪）都減掉了（哭哭）。 （術前產後胸部萎縮＋乳頭變形） 看著自己的身材慘不忍睹，進而開始尋求中醫豐胸，花了不少錢。 精神睡眠是有好一點，但胸部一點進展都沒有😭。 意外從網路得知一些隆乳的資訊，就開始做些功課。 除了上網查些相關資料，還有Line的社群可以詢問。 從開始諮詢到決定手術時間很快，因為我怕我後悔就不敢做了 既然有想法就趕快速速決定。 我前前後後總共諮詢了五家大台北知名的整形外科，這5家包含網路上網友們都極推的整外名醫，從一開始的不好意思、模糊懵懂→到知道自己想問什麼、在意什麼，而不是被診所的醫生及諮詢師牽著走。 最後，我選擇了我的隆乳命定首選：安德森整形外科！ 其中有7個因素影響我最後的決定： 本身做了些功課，我傾向胸下緣開刀，鄭明輝院長是胸下外側，跟我想要的手術開法類似。 想要影響生活最小的，因為還要帶小孩也要上班，也不想讓家人知道，本身也是忙碌的一般上班族、職業婦女，不是職業網紅、也不是演藝人員模特兒。 安德森整形外科是我第5間諮詢的整形外科診所，我自己想問的、在意的地方，包括院長、麻醉醫師到整體醫療環境、診所諮詢師，都有正中我心。 鄭明輝院長很有自信，但態度沒有很自負，講話過程中沒有因為我問了蠢問題而反駁我。 診所的裝潢很溫馨自然，從首次來現場諮詢到幾次來診所看到的患者，跟我一樣都是一般老百姓，沒有看到網紅，也沒有整型到很誇張的臉。 諮詢師在見面前的電話初步諮詢聯繫跟實際預約見面後的諮詢，後續聯繫與服務態度是一致的，沒有因為我說我還要思考就愛理不理，還是抱著盡力再為我解說、說明，服務的熱忱跟態度與專業是一致的。 鄭院長是前林口長庚醫院院長，我想這等級應該很厲害。 所以最後就決定預約了手術日期。 在手術當天，當天的刀房護理師佳怡有給我很大的心理支持。 進去刀房前我還問了她說：「如果遇到地震你們會怎麼辦？🤣」 她一直安慰我說不用擔心我會好好照顧妳。 這緩和了我手術當天很大的情緒焦慮與緊張。畢竟是要手術我的心裡還是會害怕與緊張。 【手術當天】 麻醉醫師都有跟我講解細節，在麻醉過程（我清醒時）都有跟我講解，叫我要放輕鬆，不然會打不到血管喔🤣 我很想放輕鬆啊，但是我很緊張一直在發抖 我在手術台上又想哭又想笑。（很怕手術後醒不來，怕手術後很痛，但又覺得我睡個覺起來就有大奶奶了太棒了） 我當下的臉真的是哭哭又笑笑。 在我麻醉昏迷之前，麻醉醫生跟護理師都一直有在跟我講話🤣 術後麻醉的後遺症，讓我極為不適（想吐），離開開刀房後在診所也休息了一陣子，回到家很累很想睡，但也很想吐。 這時會有一個想法冒出：為了愛美讓自己這麼不舒服何必呢？ 睡覺過程沒有很安穩，但也平順度過了第一晚。 【術後第二、三天】 起不了身請老公協助，除了動作比較緩慢外，想吐的症狀沒了（麻醉代謝掉了）。除了左右側邊肋骨跟鎖骨處會有點痛痛，其他沒有什麼疼痛感（早晚都有吃止痛藥跟抗生素）。 吃東西也可以正常吃、也可以陪小孩玩玩具、胸部假體在姿勢轉換時有不舒服感覺（有東西在動的感覺）。 【術後第四天】 自己出門洗頭去、動作依然不敢太快太大、半坐躺的方式洗頭很OK，這時的我行動自如。 【術後第7天回診】 按摩的力道比我想像的大。但按摩時都不會痛。會聽到胸部內有水聲。胸部的皮膚感覺有一點鈍鈍的。冰敷時，有一種隔空的感覺 乳頭換藥有稍微一點點感覺。但不大，壓到的話會痛。 已可以正常手伸直運動，伸展時腋下會有酸拉感。 胸部乳頭部分還是沒什麼感覺、胸部開刀處沒什麼感覺。 在胸部腫脹部分；腫在胸部跟剝離範圍，沒有水腫到肚子跟其他地方。 疼痛感部分： 一開始幾天按壓胸部會覺得一點痛，在姿勢轉換時會有假體移動的瞬間麻辣感。 老公說我是天選之人，要不是他有陪我去開刀跟幫我換藥，不然一點都不覺得我有手術。 可以按摩後，就認真按（早上起床、中午吃飯、晚上睡前） 還有每次在公司上廁所時按一下，我的胸部在2個星期回診時就覺得很軟了。 目前手術快2個月： 胸部不腫、不痛，也有下降，感覺更自然。 胸型好了，連乳頭也一起變得更美，身材好了，穿衣服更好看。 先生也更喜歡這樣轉變後的自己，因為我變得更有自信，也變得更愛自己。 還在觀望的妳 推薦給大家。我的見證與分享。

了解更多有關術後照顧的重點，患者不再需要穿戴壓力袖套、襪，但建議患者在術後接受3~6個月的復健，需要積極治療。 Post-Operative Care Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Post-Operative Rehabilitation The A+ Surgery Clinic provides comprehensive and extensive medical services before and after surgery. It is recommended that lymphedema patients receive post-operative rehabilitation for a period of 3- 6 months. It is most noteworthy that patients no longer need to wear compression garments after Dr. Cheng’s Side-to-End Lymphovenous anastomosis and vascularized submental lymph node flap transfer to distal recipient site for post-operative rehabilitation. It is recommended to massage from the proximal limb to the distal site for 15 minutes 3 times a day one month post-operatively for 3 to 6 months to further improve lymphatic drainage. Post-Operative Follow-Up The lymphedema of both upper and lower extremities can cause pain, discomfort, fibrosis, cosmetic problems, and mobility restraints for patients. It is common that lymphedema patients develop various degrees of depression due to physical discomfort, disfiguration, and emotional distress. With an average of a 2-year follow up after undergoing microsurgical microsurgery including Side-to-End Lymphovenous anastomosis and vascularized lymph node flap transfer to distal recipient site, the affected limb become softer overtime. 90% of lymphedema patients have seen size improvement with a mean circumferential difference of 50%. With the physical improvement, patients are subjectively pleased to resume daily activities and life styles they used to have. After vascularized submental lymph node flap transfer, you are asked to comply with the rehabilitation program, which includes progressive lower limb muscle strength training and reverse manual proximal (groin) to distal (ankle) lymphatic drainage. You are encouraged to gradually massage the flap, scar, and control body weight control starting after discharge. Reverse manual lymph drainage and flap massage are performed for 15 minutes/time, 3 times daily. You are advised to return to normal activity gradually as tolerated, and all other physiotherapy and compression wrapping are discontinued. Vascularized submental lymph node flap is placed on the wrist in accordance with the “pump” mechanism and effects of gravity. You do not need to wear a compression garment or bandaging after surgery but are allowed to wear a wrist brace or wrist support to hide the scar on the wrist after the wound complete healed. Another revision surgery to remove the skin paddle and superficial fat of the transferred flap to improve the cosmetic appearance and simultaneous liposuction of the thigh to decrease the production of lymph is recommended after 1 year of vascularized submental lymph node flap transfer. 1. Reverse manual lymph drainage: Time: Performed for 15 minutes/time, 3 times a day, from groin to flap. Method: Medium strength massage that compresses the skin, subcutaneous, fat and muscle in proximal (groin) to distal (flap) direction. This helps encourage drainage of the lymph drainage through the lymph flap and appropriate channels. 2. Flap massage: For increasing the venous drainage of lymph node flap pumping Time: Performed for 15 minutes/time, each 3 times daily. Method: Medium strength massage to pump lymph node flap and the scar around flap. 3. Body weight control: Time: Check body weight every day. Lighten your weight if your Body Mass Index(BMI) over 25. 4. Infection/cellulitis prevention and control: Most healthcare-associated infections are preventable through good hand hygiene. It’s important to identify and treat cellulitis early because the condition can spread rapidly throughout your body. Red area or “New red spots” of skin that tends to extend from distal to proximal Swelling Tenderness Pain Fever over 38.5℃ After the initial postoperative period, you are seen on a monthly basis by sending images. You may use any communication apps, such as Line, WhatsApp, Skype, e-mail or WhatsApp. Surgical outcomes are evaluated by your subjective improvement, circumferential measurements, the frequency of cellulitis, and via patient reported health-related quality of life outcome metrics. We will arrange ultrasonography, CT, and lymphoscintigraphy for checking the number of the lymph node on the flap, lymph node function and volume of the arm after one year.

瞭解更多鄭明輝院長首創的淋巴水腫分級評分系統，透過客觀測量和先進的影像技術來分析症狀，能夠精準盤段及確保術後最好的結果。 Cheng Lymphedema Grading Systems Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema Grading Systems Using physical exam findings, history of disease and imaging modalities, several classification schemes have been proposed to stage lymphedema. Perhaps the most widely used is the International Society of Lymphology staging system. But this staging system is based only the clinical symptoms, but no objective measurement or imaging assessment. As our understanding of lymphedema has evolved and technologies improved, other staging systems based on clinical presentation, circumferential measurements, objective measurements, lymphatic imaging or a combination thereof have been proposed. Effective and precise treatment A system adopted by the world At our center, we use the Cheng Lymphedema Grading system based on symptom severity, circumferential difference, and lymphoscintigraphy imaging to determine appropriate treatment, which was published on the Annals of Surgical Oncology, a renowned journal: A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. (Patel KM, Lin CY, Cheng MH.) and book: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015. Cheng Lymphedema Grading Chinese English 上肢淋巴水腫分期（病例） Chinese English 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. 下肢淋巴水腫分期（病例） Chinese English 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. Novel Taiwan Lymphoscintigraphy Staging System Dr. Cheng is the author of the Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging which was published in Annals of Surgery (the top Surgery Journal) in July 2018. The Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging, a comprehensive objective assessment tool that analyzes lymphedema symptoms with quantitative measurements and advanced imaging technology, can effectively help physicians evaluate the severity of lymphatic obstructions, determine the accurate diagnosis, select the most appropriate procedures to treat lymphedema, and ultimately ensure the favorable functional outcome and finest quality of life for lymphedema patients. Taiwan Lymphoscintigraphy Staging Chinese English 資料來源： Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Ann Surg. 2018 Sep;268(3):513-525 Partial obstruction Total obstruction Recommended reading journal A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 https://www.ncbi.nlm.nih.gov/pubmed/25515196 Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Ann Surg. 2018 Sep;268(3):513-525. https://www.ncbi.nlm.nih.gov/pubmed/30004927

深股動脈穿通枝皮瓣(PAP flap) 在乳房重建的運用 一直以來，腹部皮瓣（特別是深下腹動脈穿通枝皮瓣DIEP flap）是自體組織乳房重建的首選；但是有些患者腹部脂肪太少或是腹部經過多次手術（如腹部拉皮、抽脂、或是多次的腹腔手術），在這種情形下，摘取腹部皮瓣變的不可行，便要考慮來自其他部位的皮瓣，包括背部、臀部或大腿。 其中，位在大腿內側的深股動脈穿通枝皮瓣（profunda artery perforator flap; PAP flap）是一個非常好的選擇。深股動脈穿通枝皮瓣第一次在2012年，由美國Robert Allen醫師發表運用在乳房重建，此皮瓣的特點是血管解部位置變異少，脂肪厚度足夠且取皮瓣區的疤痕隱密，容易隱藏，在Allen醫師的案例中，皆成功的完成令人滿意的乳房重建。而目前長庚醫院已使用此皮瓣用在各式的顯微重建手術（包括乳房重建、頭頸部重建、婦科重建等）超過百例，相關研究已在美國整形外科醫學會表發，並獲Plastic and Reconstructive Surgery期刊登載。 深股動脈穿通枝皮瓣在手術時並不會犧牲任何肌肉，幾乎不會有無力的情形發生；而使用穿通枝皮瓣，可以早點下床， 不用住院很久，對於工作量大或運動量大的女性是很重要的一個優點。有人會擔心摘取深股動脈穿通枝皮瓣後的疤痕或對稱性，但我們的觀察與研究顯示，大腿內側的疤痕是很隱密的，並不容易被別人察覺，而不對稱性的情況也並不明顯。 比起深下腹動脈穿通枝皮瓣（DIEP flap），深股動脈穿通枝皮瓣（PAP flap）能摘取的脂肪是比較少的；但是在目前長庚醫院乳房重建中心完成的的乳房重建案例中，深股動脈穿通枝皮瓣仍能達到令患者滿意的重建結果，提供足夠隱密的疤痕，並讓患者保有腿部肌肉的力量；因此我們建議在腹部脂肪不夠的患者仍想考慮自體組織乳房重建時，深股動脈穿通枝皮瓣（PAP flap）不失為一個好的選擇。 深股動脈穿通枝皮瓣( PAP flap)手術示意圖 深股動脈穿通枝皮瓣( PAP flap)實際案例 回到乳房重建中心

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