更加認識安德森整形外科診所，包括鄭明輝院長的乳房重建及淋巴水腫權威經驗，亞洲第一位引進及執行自體組織乳房重建技術 Dr. Ming-Huei Cheng Authority in Breast Reconstruction and Lymphedema Treatment The first in Asia to introduce and perform autologous tissue breast reconstruction techniques Global pioneer in breast cancer-related diagnostic staging and microsurgical innovations Ranked among the top 2% of the world's leading scientists and renowned plastic surgeon Breast reconstruction surgery is like grafting a flower onto a new stem. Although the procedure is intricate, the sense of accomplishment is indescribable when witnessing a patient’s life transform from black and white to vibrant colors after the surgery. －Dr. Ming-Huei Cheng Meet Dr. Ming-Huei Cheng: A Pioneer in the Field of Lymphedema Treatment Patients undergoing Dr. Cheng’s microsurgical treatment for lymphedema no longer need to wear compression garments. Dr. Ming-Huei Cheng is an internationally certified plastic surgeon and the recipient of the prestigious Godina Award from the American Society for Reconstructive Microsurgery in 2006, becoming the first Asian plastic surgeon to receive this honor. To date, Dr. Cheng has performed over 2,100 microsurgical procedures, including head and neck reconstruction, breast reconstruction, extracranial-intracranial arterial bypass surgery, lymphaticovenous anastomosis (LVA), and vascularized lymph node flap transfer. Meet Dr. Ming-Huei Cheng: A Pioneer in Breast Reconstruction In Taiwan, approximately 16,000 new cases of breast cancer are diagnosed annually, yet less than 5% of patients undergo breast reconstruction after mastectomy. Over 20 years ago, Dr. Ming-Huei Cheng began his work in the field of endoscopic breast reconstruction. To date, he has helped over 1,000 women who have lost their breasts regain their confidence through reconstruction. Breast reconstruction surgery is often compared to “grafting a flower onto a new stem.” While the procedure is intricate and labor-intensive, the indescribable sense of accomplishment comes from witnessing patients’ lives transform from black and white to vibrant colors after surgery. In 1998, under the direction of Professor Fu-Chan Wei, then Dean of Chang Gung University’s School of Medicine, Dr. Cheng traveled to the MD Anderson Cancer Center in the United States to specialize in breast reconstruction. Before his departure, Professor Wei advised him, "You must become Asia's leading expert in breast reconstruction!" After a year and two months of training, Dr. Cheng returned with new concepts and techniques, exceeding expectations. He pioneered the globally acclaimed Deep Inferior Epigastric Perforator (DIEP) Flap Surgery, a method that uses the patient’s abdominal fat for breast reconstruction. This approach not only addresses the discomfort of traditional saline implants but also achieves natural symmetry and breast enhancement. His groundbreaking procedure has been published in the authoritative international journal Plastic and Reconstructive Surgery. 媒體採訪 1 / 在八仙塵爆的危難中，帶領醫護團隊與死神拔河； 在病房裡，他親自執刀超過2700台手術，用一針一線縫回生命的尊嚴 YouTube影片 緯來財經報導 2 / 乳房重建 再現「身」與「心」的 圓滿人生 可由下列媒體觀看 理財週刊 3 / 乳癌切除不只留疤！醫曝1/4會憂鬱　乳房重建+平衡性手術=人生修復鍵 可由下列媒體觀看 ETtoday新聞雲

除皺復新~永保平滑V臉的最高肌密 對抗皮膚鬆弛下垂,不論是法令紋、抬頭紋、木偶紋或魚尾紋等，可以靠注射肉毒桿菌，玻尿酸，脂肪填充等微整形讓妳恢復青春美麗。也可以做內視鏡拉皮手術，讓您有感皮膚的緊緻。 除皺緊緻療程 Wrinkle removal Treatment 保養品達不到的效果，漸進式拉提能幫妳 路見不平，立即熨平~~ 除皺復新~永保平滑V臉的最高肌密 對抗「臉部、眼周、全身性」皮膚鬆弛下垂 平皺補凹、緊緻肌膚、 重塑輪廓線條 最新皮膚「熨平技術」強勢登場，幫妳快速找回年輕感 都有在用保養品，為什麼我的皺紋還是越來越多呢？ 皮膚表面是由彈性纖維及膠原蛋白所組成的，隨著年齡增長或保養不足，都會影響皮膚的彈性和緊緻度，日積月累就會造成皮膚鬆弛及表面出現皺摺細紋，此現象不只會出現在臉上，也會發生在全身各部位 。 醫師會怎麼診斷和治療皺紋？ 醫師會經由直接觀察臉部表情及肌肉活動來進行評估，可了解皺紋的種類、形成的原因，以便提供對症有效的治療建議。 皺紋的形成原因有哪幾種？ 根據出現的位置及形成原因，皺紋可分為2大類： 1.動態紋： 面部表情需經肌肉收縮及皮膚拉伸才能產生，長期下來形成的紋路稱為動態紋，又稱表情紋，如抬頭紋、眉間紋、魚尾紋及笑紋。 2.靜態紋 主要因素為膠原蛋白流失及彈性纖維斷裂，當臉部沒有做任何表情時，就已存在的紋路，稱為靜態紋，如法令紋、木偶紋、頸紋。 想讓皺紋消失，有哪些治療方式可以選擇？ 以下是改善皺紋問題常見的幾種治療方式： 1.日常保養 外出時要避免長時間陽光曝曬，可選擇合適的防曬產品來阻絕紫外線，以延緩肌膚老化；每日清潔臉部時可挑選溫和型卸妝品，減少拉扯及搓揉肌膚；保養品方面優先選擇保濕類產品，更能有效鎖住水分，維持肌膚光滑。 2.注射肉毒桿菌 肉毒桿菌是從細菌的分泌物經高科技純化，萃取出來的蛋白質，可以用來阻斷運動神經末梢的傳導功能，治療過度活耀的肌肉，使引起皺紋的肌肉放鬆。治療過程中會有針扎感，但只作用在治療部位，並不影響其他表情動作，不會有臉部僵硬的問題，效果通常可維持4~6個月。 3.注射玻尿酸 外用塗擦的玻尿酸僅有保濕效果，無法減少皺紋;而注射用玻尿酸是一種透明的多醣類膠狀物質，可用來填補皮膚的印痕及凹陷處。在注射肉毒桿菌減少表情皺紋活動的同時，建議一併注射玻尿酸將皺紋填平，以達到相輔相成的加強效果。 4.注射維生素 以高濃度的維生素透過點滴注射，促進膠原蛋白增生，並加強肌膚修護力，但須頻繁施打。 5.脂肪填充手術 醫師從治療者身體取出定量脂肪，多選擇腹部、背部或大腿等處的脂肪，經特殊的離心洗淨與淘選後，再注射到想填補的皺紋處，其優點為利用自體脂肪可降低排斥問題，傷口僅約為針孔大小，術後脂肪穩定期約3個月，建議此期間內勿減肥，以維持更好的效果。 6.內視鏡拉皮手術 做法是將皮膚的皺褶拉緊，切除多餘的脂肪和皮膚後進行縫合，通過手術修復臉部結構和組織，減少皺紋並改善臉部輪廓。因使用的是內視鏡手術，只需要在前額髮線後開小洞即可手術，較傳統型拉皮手術有更多好處，如傷口小更容易照護，且減少疤痕形成並可加速復原時間。 7.Thermage FLX 鳳凰電波 屬於非侵入性治療，不會有任何傷口，是利用每秒678萬次的高頻率電流，在深層皮膚產生55~65度的熱能，以刺激膠原蛋白新生，達到撫平細紋、提升膚質、緊緻肌膚及重塑輪廓的效果，治療方式中包含脈衝技術，以環繞式施打來提升舒適度，及AccuREP技術使每一療程區域有完整且一致的能量，大幅優化療程效能。 鳳凰電波不僅臉部可施打，也適合眼周、四肢皺褶或身體橘皮部位皆可做此治療，且療程的後續照顧簡單，僅需正常保濕及防曬，視情況能維持1~2年。 我不知道怎麼選擇治療方式，該如何諮詢? 皺紋治療的方法種類繁多，歡迎至安德森整形外科診所諮詢，您可藉由整形外科醫師的專業評估，經與個案管理師諮詢溝通後，審慎的選擇出對您最適合的治療方案。

Accommodation Information 從台北車站到安德森整形外科、 從桃園機場到安德森整形外科 Accommodation Information Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 從台北車站到安德森整形外科 Transportation routes 點擊開啟Google map Take the bus 63號公車 至中山國中下車 點擊查看公車路線 49號公車 至民權復興路口下車，步行4分鐘 點擊查看公車路線 Take the MRT 台北車站搭乘板南線（藍線）至忠孝復興站， 再轉搭文湖線（棕線）至中山國中 站 從桃園機場到安德森整形外科 Transportation routes 點擊開啟Google map Take the bus 63號公車 至中山國中下車 點擊查看公車路線 49號公車 至民權復興路口下車，步行4分鐘 點擊查看公車路線 Take the MRT 台北車站搭乘板南線（藍線）至忠孝復興站， 再轉搭文湖線（棕線）至中山國中 站 A+ Surgery Clinic is located on Fuxing North Road in Songshan District, Taipei City. Below are some hotel information around the neighborhood, providing various options for your stay. 五星級 文華東方酒店 台北市敦化北路158號，步行約15分鐘 Read More 台北五星 JR東日本大飯店 台北市中山區南京東路三段133號，開車約6分鐘 Read More 四星級 台北國泰萬怡酒店 台北市中山區民生東路三段6號，開車約6分鐘 Read More 四星級 兄弟大飯店 台北市南京東路三段255號，步行約10分鐘 Read More 四星級 台北馥敦-馥寓 台北市復興北路315號，步行約2分鐘 Read More 三星級 承攜行旅 台北復北館 台北市松山區復興北路307號，步行3分鐘 Read More 三星級 新驛旅店 復興北路店 台北市復興北路338號，步行約2分鐘 Read More 三星級 復新文旅Forever Inn 台北市中山區復興北路282號3F，步行3分鐘 Read More

一旦您確認並接受了鄭教授的治療計劃，您的醫療協調員(個管師)將聯繫您，仔細檢查並確認您之前預約的日期。國際患者我們將為您做好必要的旅行簽證準備、機場接機和酒店住宿，也會讓您與我們方便聯繫。 Travel Visa What is a visa? A visa is a permission certificate or a stamp on a non-citizen applicant’s passport to enter a particular country. To apply for a visa to Taiwan, please visit a Taiwan Representative Office nearest to you. Types of Visas to Taiwan: Visitor, Business Visa: (effective for 7 to 30 days) A U.S citizen doesn't need a visa to visit Taiwan for up to 30 days. Please apply for your visa before your arrival in Taiwan, if you are not a U.S. citizen. For most patients, a visitor visa should offer sufficient time to undergo most kinds of medical checkups, examinations, and treatments. In the event that you are required to stay for longer than one month, we will assist you in applying for a medical visa. A formal certificate of diagnosis will be provided to you for the request of time extension for a medical visa. Landing Visa / Visa Exemption Please complete the immigration card WHILE on board the incoming flight. Citizens of some countries are eligible for a landing visa or visa exemption, which permits individuals to enter Taiwan without prior visa application for a duration of 30 to 90 days. Please click on the link on landing visa for more information. Please click on the link on visa exemption for more information. Entry Permit for Certain Passport Holders For citizens of certain countries, such as Pakistan, Iraq, Myanmar (Burma), Ethiopia, Nigeria, and Afghanistan, a formal medical visa letter signed by our hospital’s doctor will be required to gain entry into Taiwan. Travel Information Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Once you have confirmed and accepted your treatment plan, we will contact you to double-check and confirm the dates of your previous appointments. We will prepare the necessary travel visa, airport pick-up and hotel accommodation for you, and also make it easy for you to contact us. Travel Destination Known as the “heart of Asia”, Taiwan is packed with exciting things to do, beautiful sights to see, amazing food to try, festivals to enjoy, and friendly people to meet. Taiwan is famous for its landscape, rich heritage, diverse folk traditions, mild climate, magnificent temples, and numerous national museums. It has become a very popular travel destination in Asia because of its convenient and efficient transportation system, safe and secured environment, kind people, and affordable cost of travel. Taiwan’s unique tourism attractions – the combination of traditional Asia and the modern world, the contrast between metropolitan and countryside, the blending cultures of the old and the new, stunning scenery of mountains, coastlines and valleys, and tasty local food and international cuisines – bring tourists back to this beautiful island year after year. Taipei 101 Located in the finest district Taipei has to offer, TAIPEI 101 is the largest engineering project ever in the history of the Taiwan construction business. At 382 meters above the ground the 89F Observation Floor offers visitors a commanding view of the city and Taipei Basin at all directions. Yehliu Geopark Yehliu Geopark is truly a park of natural wonders: rocks carved by wave-cutting and weathering over years and years were formed into shapes resembling figures that are real. The most famous one is of course the Queen’s Head, among other “statues” that are named the Fairy’s Shoe, the Mushroom Rocks, the Tofu Rocks, and the Elephant Rocks, along with many interesting potholes. Do not forget to bring your camera. Sun Moon Lake The Sun Moon Lake National Scenic Area is praised for its five major recreational systems, including the lake, Shueili River, Puli, Jhuoshuei River, and Jiji. The surrounding areas stretch to cover known tourist spots including Taumi, Checheng, Jiji, Shueisheda Mountain, Sangyong Falls, Mingtan Reservoir, and Shueili River. Sun Moon Lake features the only full-range 3D tours (lake, sky and land) in Taiwan. The lake cycling trail has been recognized by CNNGO, CNN as one of the most beautiful cycling trails in the world. *Travel Visa Information : National Immigration Agency www.taiwan.net.tw Taroko National Park Taroko is famous for its spectacular mountains and marble canyons. Cliffs and canyons stretch along Liwu River. The waterfalls characterized Taroko National Park and the most famous ones are Baiyang Waterfall, Yindai Waterfall, Changchun Waterfall, and Lushui Waterfall. Swallow Grotto (Yanzikou) and Tunnel of Nine Turns (Jiuqudong) are the most impressive natural scenes in Taroko and the canyons here are the narrowest.

先天性乳房缺損-波蘭氏症候群 找回自信、健康與美麗！ 在1841年，Alfred Poland 首先發現沒有胸大肌的病人，後來稱之為波蘭氏症候群，此症候群包括部分胸大肌缺損或發育不全，同側併指骨，併指畸形，乳房發育不全。病人從症狀很輕到很嚴重都有，甚至會影響到前鋸肌、闊背肌等肌肉，及肋骨扁平或部分肋骨缺損，有時會併發雞胸、漏斗胸、脊柱側彎。 國外波蘭氏症候群的發生率報告指出約一萬至十萬個出生嬰兒中有一個，右側是左側發生率的二倍，男性與女性發生機會相同，但女性病患較多向整形外科醫師尋求乳房重建。波蘭氏症候群的發生原因尚無定論，有人說是血管不正常或外傷引起，也有是遺傳引起的說法。 大部分的此類病人不會有太大功能障礙，手的畸形也是輕微的症狀。診斷包括病史，特別是產前的病史，理學檢查，包括胸部、肩部、手部，作血清免疫檢查以排其他疾病的可能，若有胸肋骨發育不全，應作胸部電腦斷層。最早的乳房治療方法是植入義乳 (implant)，但是不管是矽膠或生理食鹽水袋，其效果並不好，因為胸大肌的缺損常會造成球狀攣縮 ( capsular contracture )，皮膚太緊乳房形狀也不好看。 第二個方法是植入組織擴張器 (tissue expander )，經過二至三個月的注射生理食鹽水，將組織擴張器撐大，皮膚撐鬆乳房撐出空間，然後再更換成永久性的義乳，此方法也有發生莢膜攣縮的機會，乳房形狀較自然。 第三個方法是用局部皮瓣轉移，可以用闊背肌皮瓣來轉移。闊背肌在此類病人有時也會發育不全，而且其脂肪量有時不夠，會需要加一個義乳才夠，闊背肌肌肉觸感較硬。 第四個方法是使用自體脂肪轉移，利用腹部脂肪 (DIEP flap )連帶著供應營養的血管轉移的優點，而且較不會痛不犧牲橫腹直肌，手術成功後，乳房永久自然柔軟，病人滿意度是最高的。 右側波蘭氏症候群01 右側波蘭氏症候群02 回到乳房重建中心

專業麻醉醫師團隊，手術更安心。 認識蕭斯云 醫師和馮育斌 醫師 和他們的專業背景，讓您以及家屬都能放心 A professional team of anesthesiologists, making surgery safer Our team is professionally licensed and every operation is fully monitored, giving you and your family peace of mind. 蕭斯云 醫師 學歷 中國醫藥大學 醫學系 經歷 台北國泰綜合醫院 麻醉科 住院醫師&總醫師 台灣麻醉醫學會 專科醫師考試合格 衛生福利部立金門醫院 麻醉科 主治醫師 台北國泰綜合醫院 麻醉科 兼任主治醫師 沐美診所 麻醉主治醫師 三重宏仁醫院 麻醉科 兼任主治醫師 馮育斌 醫師 學歷 國防醫學院醫學系 經歷 台中榮民總醫院麻醉部住院醫師 台北國泰綜合醫院麻醉科主治醫師 日本東京醫科齒科大學齒科麻醉科研修醫師 汐止國泰綜合醫院麻醉科主治醫師 專長 兒童牙科門診鎮靜 成人牙科門診鎮靜 整形外科麻醉 產科麻醉 現職 舒美麻醉醫療團隊主治醫師

瞭解更多手臂淋巴水腫的成因及症狀，以及為何安德森整形外科是您的安心選擇，有任何問題歡迎電話及線上諮詢。 Upper Extremity Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery What Is Upper Extremity Lymphedema? Breast cancer patients who underwent axillary lymph node dissection following radiotherapy are at a higher risk of developing extremity lymphedema – Breast Cancer-Related Lymphedema (BCRL), a condition that results in tissue swelling and liquid retention in the arms. While it is possible to manage the condition with some home care, surgery may be necessary to significantly improve an individual’s comfort and quality of life. Ming-Heui Cheng, MD, FACS, a pioneer in plastic microsurgery and internationally renowned lymphedema specialist, performs vascularized lymph node flap transfers on lymphedema patients whose symptoms have not improved or continue to worsen six months after they emerged. Symptoms Of Lymphedema Of The Arm The affected limb may develop inflammation, infection, adipogenesis, and fibrosis of the tissue. The protein-concentrated fluid that accumulates inside the interstitial tissue may further block or make the drainage of the lymph fluid less efficient or even create an obstruction. Lymphedema of upper extremity causes pain, heaviness, skin hyperkeratosis, fibrosis, discomfort when wearing certain clothes and jewelry, cosmetic problems and limitation of daily activities for patients. It is common for lymphedema patients to experience depression, due to physical discomfort, emotional distress and lower quality of life. 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. Surgical Techniques 1 Lymphaticovenous Anastomosis, LVA LVA is an advanced minimally invasive super-microsurgical technique used to relieve lymphedema. During the procedure, Dr. Cheng will make small incisions, which expose lymphatic channels and small veins just beneath the skin. Learn more 2 Vascularized Lymph Node Flap Transfer, VLNT In some cases, surgery may be performed to alleviate swelling and reduce symptoms. Dr. Cheng has developed a unique technique that involves lymph node transfer. During the procedure, Dr. Cheng transfers lymph node flap to distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity. Learn more Case 61-year-old female with breast cancer-related lymphedema in the right upper limb 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. 53-year-old patient, right upper limb lymphedema clinical grade II 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. 39-year-old female, left upper limb lymphedema, grade 1 Before Surgery: This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. After Surgery: At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. 49-year-old female, right upper limb lymphedema, grade 1 Before Surgery: This is a 49-year-old female with right upper limb lymphedema for 6- months after right mastectomy and axillary lymph nodes dissection and radiation. After Surgery: At a 20- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 85% and 60% above the elbow and below the elbow, respectively. Recommended reading journal 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 https://www.ncbi.nlm.nih.gov/pubmed/19337095 Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Plast Reconstr Surg. 2013 Jun;131(6):1286-98. https://www.ncbi.nlm.nih.gov/pubmed/23714790 Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Engel H, Lin CY, Huang JJ, Cheng MH. Ann Surg. 2017 Jun 7 https://www.ncbi.nlm.nih.gov/pubmed/28594742 Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. https://www.ncbi.nlm.nih.gov/pubmed/28507857 The Submental versus Groin Vascularized Lymph Node Transfer Flaps: A Head-to-Head Comparison of Surgical Outcomes for Breast Cancer Related Lymphedema Ho OA, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 [Epub ahead of print] 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

鄭明輝教授是經過國際專業認可的整形外科專科醫師，同時也是美國重建顯微外科學會2006年Godina獎得主，是第一位亞洲整形外科醫師得獎者。截至目前為止，鄭教授已經完成了2100多例顯微手術，包括頭頸部重建、乳房重建、顱內外動脈血管吻合手術、淋巴管靜脈吻合術和顯微淋巴結皮瓣移植手術。 Gallery Treatment of Mild to Moderate Lymphedema Lymphaticovenous Anastomosis (LVA) - Upper Limbs Case 1 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 57-year-old female with left upper limb lymphedema for 12- months after left mastectomy and radiation. At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 25% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 12- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 71% and 100% above the elbow and below the elbow, respectively. At a 15- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 86% and 100% above the elbow and below the elbow, respectively. Case 2 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 56-year-old female with right upper limb lymphedema for 10- months after right mastectomy and axillary 31 lymph nodes dissection and radiation. At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. At a 12- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 24- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Case 3 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 64-year-old female with left upper limb lymphedema for 12- months after right mastectomy and axillary lymph nodes dissection and radiation. At a 11- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 65% and 70% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 18- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 55% and 40% above the elbow and below the elbow, respectively. At a 24- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 90% and 50% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Case 4 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. Case 5 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 49-year-old female with right upper limb lymphedema for 6- months after right mastectomy and axillary lymph nodes dissection and radiation. At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 80% and 50% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 20- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 85% and 60% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs Case 1 Lymphaticovenous Anastomosis (LVA) - Lower Limbs This is a 50-year-old female with right lower limb lymphedema for 14 years after cervical cancer and radiation. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 40% and 30% above the knee and below the knee, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs At a 7-months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 25% above the knee and below the knee, respectively. Case 2 Lymphaticovenous Anastomosis (LVA) - Lower Limbs This is a 36-year-old female with left lower limb congenital lymphedema for 12 years. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 60% and 30% above the knee and below the knee, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs At a 12-month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 60% and 40% above the knee and below the knee, respectively. Case 3 After cervical cancer This is a 62-year-old female with bilateral lower limb lymphedema for 24-months after cervical cancer and radiation. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 20% above the knee and below the knee, respectively. Case 4 After cervical cancer This is a 67-year-old female with grade I left lower limb lymphedema and grade IV right lower limb lymphedema for 14 years after cervical cancer and radiation. At the 16 days of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms and extremity tightness. Left lower limb was received.

自體脂肪移植(Fat grafting) 自體脂肪移植可以說是近年來最夯的整形手術之一，在報章雜誌與電視節目上，亦時常討論此項主題，常見的臨床運用包括： 1.臉部凹陷填補 （淚溝填補、豐頰、太陽穴填補、隆鼻、蘋果肌、豐下巴） 2.乳房畸形的矯正 （可運用於隆乳或乳房重建） 事實上，這是一種整形外科醫師長久以來施行的常規手術，只是在最近十幾年，於基礎研究、臨床發展與技術上有長足的進步，讓此項手術變得更安全更有效率，也因此造成了一股流行。但在這股流行的背後，卻藏有許多不為人知的商業行銷手法，不僅過份了自體脂肪移植的療效，甚至因脂肪注射過多而造成患者的傷害，在醫學中心行醫的我們，實有責任將自體脂肪移植的安全性，發展與趨勢好好解釋一番。 自體脂肪移植的手術過程可分為三個步驟： 第一個步驟是「抽脂」：是使用抽吸管，在負壓的狀態下將身體特定部位的脂肪抽出；至於何處的脂肪較適合移植，目前沒有一定的結論，但一般而言認為下腹部與大腿內側的脂肪品質較好，適合移植。 第二個步驟是「脂肪純化的處理」：透過洗條、過濾或離心的方式，將脂肪顆粒純化出來；此步驟主要在將血水與破裂的脂肪清除，將完整的脂肪顆粒保存來。 第三個步驟是「脂肪顆粒的注射」：用特殊的注射器械與注射管，將脂肪顆粒注射入需要填補的部位。 這三個步驟中每一步都非常重要，有理想的抽脂，處理與注射方式，才能達到完美的注射結果；除此之外，絕對無菌的消毒與準備，與正確的術後照顧也是手術成功的關鍵；另外術前術後的戒煙也是非常重要!! 而注射部位的條件，對於結果也有絕對的影響；一般而言用於臉部注射時，每個部位約1-3 c.c.的脂肪就足夠了，脂肪移植的量較少，且存活率高，通常注射1-2次即可達到完美的結果；但用於乳房的畸形矯正時，則常需要數十到數百c.c.之間，脂肪移植量較多，且因存活率較低，通常需注射2-3次以上，才能達到滿意的結果；造成這些差別的主要原因如下：1.臉部的血液循環較好，因此移植的脂肪較易存活；2.單一區域（乳房）進行大量的脂肪注射時，因而造成局部壓力增大，血循不足而造成脂肪不易存活。 手術原理： 抽取的脂肪，填補至缺損部位，須先將攣縮放鬆形成一個空間，脂肪細胞注入後，由周圍組織提供血液循環供應，達到脂肪移植存活目的。 手術次數： 少量多次施打(一次填補太多的脂肪容易造成脂肪存活率不佳，易發生鈣化或脂肪壞死)，視缺損部位及個別狀況而定，平均約2~3次，手術時間約2~3小時。 合併症： 包括：感染、鈣化、脂肪壞死、血腫及膿瘍等，若有脂肪壞死或感染、膿瘍的風險，一旦發生就必須手術來改善此情況。 手術成功率： 脂肪存活率約五至七成，部分脂肪體內會自行吸收。極少數會因為感染等問題，造成脂肪和周圍組織的流失，需要手術來改善此情形。 而其中將自體脂肪用於隆乳，是目前最熱門的諮詢項目之一；但我們也曾見到患者全身上下都被抽脂過，只為了一次將兩邊的A罩杯變成C罩杯，經過半年後，脂肪被吸收大半，想再接受第二次的自體脂肪移植時卻已找不到「原料」，只能改用義乳隆乳，不僅花錢，且又傷身，對患者可說是二次傷害。基本上不論是用於隆乳或用於矯正乳房畸形，以目前的技術發展，至少2-3次的注射，每次相隔至少三個月，仍是必經的過程；此位患者就是在第一次手術前，以為一次脂肪注射就可達到很好的效果，實則是被商業行銷手法所誤。 在接受手術之前，應了解上述脂肪移的原理，與醫師詳盡的溝通，了解自己是否適合接受自體脂肪移植手術，對結果有『合理』的期待，並在手術後好好休息，是手術成功的不二法門! 常見問題 1.　是否有萃取脂肪幹細胞？ 移植的脂肪中，確實含有少量幹細胞，但是數量很少，此手術並未特別萃取幹細胞。 2.　術後一個星期內避免任何劇烈運動，包括跳舞或擴胸等運動，但可做日常生活活動。術後第二週開始即可恢復平常的運動。 3.　抽脂部位，因未抽取大量脂肪，不會造成皮膚凹凸不平，不需特別穿著束身衣或束褲。 4.　術後乳房仍可做乳房篩檢，包含乳房攝影或超音波等檢查，因少量多次施打脂肪，可避免造成脂肪硬化或壞死等情形，影響乳癌的判讀。在有經驗的乳房外科醫師判讀下，可以辨識出移植的脂肪組織，以及可疑的損傷。 手術成果 脂肪游離片注射 (1) 脂肪游離片注射 (2) 脂肪游離片注射 (3) 回到乳房重建中心

Lymphedema FAQ for patients outside of Taiwan. Feel free to contact us if you have any other questions Prepare vascularized submental lymph node flap transfer surgery Q1 How long is the stay, to comfortably prepare for surgery and complete postoperative care? One week. Q2 At which hospital or facility would the surgery actually be performed? A+ Surgery Clinic has the state of art 42X Mitaka microscope, 3 operation rooms, and professional anesthesiologists, full-time RNs, and 7 private rooms for admission. Q3 Will you and your office coordinate all aspects of care? Yes. All of our patients are well cared for. Q4 Who will be the point person before, during, and after the surgery? Miffy Lin, Ph.D., chiayumiffy@gmail.com Q5 Do you have any logistical leaflet you could share that is aimed at international patients like us? No. You may check our website: www.lymphedemamicrosurgery.com Surgical procedure, from planning to post-operative care Q1 Do you need MRI, lymphoscintigraphy, and ICG, OR are one or two of those sufficient? If so, which is/are preferable in terms of balancing accuracy of diagnosis /surgical course vs radiation or other risks? Lymphoscintigraphy and ICG are required to make an accurate diagnosis and staging for the treatment, either LVA or VLNT. MRI does not help for the treatment. Q2.1 Before travel to Taiwan, are other tests (beyond imaging) needed to determine the appropriate surgical procedure? Please check platelet count, since the heparin-induced thrombocytopenia and thrombosis is the most common complications post VLNT, specially for those patients with heparin exposure such as the Port-A insertion for chemotherapy. Q2.2 Before travel to Taiwan, are there any medical records that we should be sending you? Surgical record, pathology reports, Lymphoscintigraphy and ICG. Q3 Upon arrival in Taiwan: what are the salient pre-operative steps? CBC/DC, Chest X-ray, EKG, Lymphoscintigraphy and ICG. Q4 Would you personally be performing the surgery, irrespective of the surgical path you deem best? I personally perform the surgery through the entire procedure. Q5 What other specialists, if any, would be part of my medical team? I personally perform the surgery through the entire procedure. Q6 How long does the surgical procedure itself last? LVA: 2 hours, VLNT 4-5 hours. Q7 How long is the hospital stay? LVA: 2 days, VLNT 5-7 days. Q8 How much pain should my reasonably expect and for how long? Not much pain immediate postoperatively, most patients do not need intravenous pain killer. Q9 What are the salient risks of undergoing the surgery itself? How likely are they? The heparin-induced thrombocytopenia and thrombosis (HITT) is the most common complication post VLNT, about 15 %, especially for those patients with heparin exposure such as the Port-A insertion for chemotherapy. HITT will develop the local pedicle artery or vein thrombosis, which will affect the survival and function of the VLNT. Infection is rare. Q10 What are the post-operative risks or adverse effects of the procedure? How likely are they? See above answer. Q11 Can you briefly describe anew (our notes are a bit confusing) the salient difference between your approach and the "main US alternative" we discussed (Cleveland Clinic)? The side-to-end lymphovenous anastomosis is the better drainage for extremity lymphedema without wearing compression postoperatively. The lymphatic vessels require contraction to push the lymph from distal to proximal, from dependent site to axilla. If the lymphatic vessels are divided and lost its continuity during end-to-end anastomosis, all the segments of lymphatic vessels will lose their continuity and contraction function, which lost the drainage function eventually. Q12.1 What are the key benefits of your approach compared to the main US alternative? Is your approach substantially less invasive than the main US alternative? Yes, one side-to-end LVA at the distal forearm is less invasive, no trauma to other healthy lymphatic vessels. No compression garments are required postoperatively. Q12.2 What are the key benefits of your approach compared to the main US alternative? Is your approach substantially lower risk? Yes. Q12.3 What are the key benefits of your approach compared to the main US alternative? Is the reduction in lifetime risk of infection/cellulitis substantially greater? Yes. Once the lymph has been adequately drained into venous system through side-to-end LVA daily, estimated 500 cc per day, the infection and cellulitis has significantly decreased. Q12.4 What are the key benefits of your approach compared to the main US alternative? Is the reduction in other lymphedema-related risks/co-morbidities substantially greater? Yes, mainly the infection, swelling, and appearance. Q12.5 What are the key benefits of your approach compared to the main US alternative? Is reduction in arm circumference substantially greater? Yes. Q12.6 What are the key benefits of your approach compared to the main US alternative? Is the absence of need for post-surgical compression unique to your approach? Yes. Q13 Taking into account the unique benefits of your approach, are there any countervailing potential risks or disadvantages that we should consider, relative to the main US alternative? No countervailing potential risks in side-to-end LVA. The temporary cosmesis in the distal recipient site, the potential HITT in VLNT. Q14 You indicated a 98% success rate for the procedure, which is remarkable and very comforting. Are there clinical indicators that can determine if my is at high risk of being in the 2%? If the ICG demonstrating the lymphatic vessels are available at the forearm. Q15 About post-operative care, what does the post-operative care in Taiwan involve? You may visit the testimonials of our patients via Youtube at https://www.youtube.com/watch?v=IINbv0xZdWQ , and https://www.youtube.com/watch?v=NwCw_SQnAPI . Q16 About post-operative care, once we are back home, is there someone you trust in NYC to collaborate with, so as to ensure any follow up care is performed to your standards of excellence? Dr. Joseph Dayan at Memorial Sloan Kettering Cancer Center. Q17 About post-operative care, how likely is it that we would need to travel to Taiwan anew for follow up care or procedures? One year post-operatively. Q18 Is there a risk that the two long flights from /to NYC might defeat the benefits of the surgery itself? No. I have quite a few international patients from US, Canada, Rusia, Sweden, Dubai, Saudi Arabic, India, and Iraq. Q19 I am on Anastrozole, Verzenio, Minoxidil. Are any of those of concern as it relates to surgery? No. Q20 Considering the most promising current /known avenues of research for an actual cure over the next 5 to 10 years, is the surgery likely to foreclose applicability of such potential cures? In my opinion, the side-to-end LVA can cure the early grade lymphedema, and VLNT can cure the late grade lymphedema without wearing compression garments. I think there may be some innovation for the treatment of lymphedema in the next 5-10 years. Managing symptoms & caring for my lymphatic system today Q1 How long is the stay, to comfortably prepare for surgery and complete postoperative care? We followed your advice not to bandage. Can you briefly provide anew the key rationale for your recommendation? (Please forgive our anxiety; bandaging seems to be the standard of care in the US.) Bandage and compression garments are not helping the drainage of lymph in the extremity daily. 10% of arterial blood become the lymph(estimated 500 cc /day in the upper limb) in the interstitial, then the lymph accumulates through the lymphatic vessels to axillary lymph nodes, which continuously drains to thoracic ducts, and to venous system. Bandage and compression garments will affect the contraction of the lymphatic vessels. Although the lymphedematous limb seems not swelling, but the lymphatic vessels will be fibrotic changed quickly. Q2 Are there demonstrably helpful non-surgical treatments or routines that I can start now to manage symptoms or protect her lymphatic system (e.g.: exercises, lymphatic massage by certified therapist, acupuncture, diet, arm elevation)? Exercises including yugo, biking, swimming and golfing within 3 hours each time are helpful for circulations. Lymphatic massage is helpful too. Please remember the lymph production is 10% of the arterial flow. Diet control is good. Arm elevation with one pillow during sleep is good. Financial aspects Q1 What is the all-in cost of the procedure? Please ask Miffy for the details of the cost of possible procedures. Q2 Is this cost fixed /guaranteed? Please ask Miffy for the details of the cost of possible procedures. Q3 Are you amenable to working with our insurance (BUPA in the United Kingdom) to ensure they provide us with pre-authorization, so that we can be reimbursed. We regret to inform you that we are unable to accept BUPA insurance policies at this time. However, we would be happy to discuss alternative payment options Get in Touch FAQS About Lymphatic System & Lymphedema