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認識更多原發性淋巴水腫的存在、發展的原因，診斷方式、治療方法，以及為何專業的安德森診所是你最好的選擇。 Primary Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Symptoms of Primary Lymphedema Primary lymphedema is the presence or development of lymphedema without any relation to any underlying medical condition. Primary lymphedema has a quoted incidence of approximately 1-3 births out of every 100,000 births, with a particular female preponderance to male ratio of 3.5:1 worldly. In North America, the incidence of primary lymphedema is approximately 1.15 births out of every 100,000 births. Primary lymphedema can be classified depending on the age of onset of the patients: at infancy (birth to 1 year), during childhood (1-8 or 9 years), during adolescence (9-21 years), and lastly during adulthood (after 21 years). Mutations in VEGFR3 (Milroy disease), CCBE1 (Hennekam syndrome), SOX18 (hypotrichosis-telangiectasia-lymphedema), and FOXC2 (lymphedema distichiasis) are several eponymous conditions that present at birth and involve the development of lymphedema. Familial lymphedema of the lower extremities that presents itself during adolescence is known as Meige disease. Its underlying genetic abnormality is not known yet, but its familial nature and presentation at adolescence are characteristics of it. Primary lymphedema often occurs at birth and for causes or by mechanisms that are unknown. When primary lymphedema becomes symptomatic in adulthood, these patients often have a long-standing history of lymphedema that is associated with the destruction of lymphatic channels. Adipogenesis or proliferation of adipose tissue coupled with dense fibrosis often results in severe lymphedema of the limb and a more severe presentation. Severe fibrosis occurs with long-standing lymphedema due to the accumulation of protein-rich fluid in the interstitial spaces coupled with inflammation repeated bouts of cellulitis. Diagnosis of Primary Lymphedema Pre-operative lymphoscintigraphy and indocyanine green (ICG) lymphography are used to detect the presence of any intact lymphatic channels. If a lymphatic duct is available at ICG lymphography, the patient is offered the lymphovenous anastomosis (LVA), whereas those without patent lymphatic ducts are indicated for vascularized lymph node transfers (VLNT). If the lymphoscintigraphy shown total obstruction, the patients are offered VLNT directly. Ultrasound Doppler is used to evaluate the concomitant vascular lesions at the proximal site. Single-photon emission computed tomography (SPECT) is indicated for those patients with suspected concomitant chylous ascites. MRI is prescribed for the evaluation of donor site lymph node basins of neck if the vascularized lymph node flap is indicated. Lymphoscintigraphy computed tomography (CT) indocyanine green (ICG) lymphography Treatment Of Primary Lymphedema Both Vascularized lymph node transfers (VLNT) and lymphovenous anastomosis (LVA) are surgical treatments that have been proven effective in treating secondary lymphedema. VLNT involves the microsurgical transfer of lymph node-containing tissue to a lymphedematous limb, which works based on the movement of lymphatic fluid from the affected limb into the transferred lymph node and drainage via the newly anastomosed venous route. We have reported a paper to compare the results of VLNT and LVA treatments of lymphedema. 80% of primary lymphedema required a VLNT for the functional recovery and 20% of primary lymphedema may undergo a LVA. At a mean follow-up of 20 months, mean circumferential reduction of limb circumference and episodes of cellulitis were 3.7 ± 2.9 cm and 1.9 ± 2.9 cm; 5.1 ± 2.8 times/year and 4.2 ±0.5 times/year in VLNT and LVA groups, respectively (p = 0.7). Improvements in overall score of the Lymphedema quality of life questionnaire (LYMQoL) (from 3.9 ± 1.2 to 6.4 ± 1.1, p < 0.05) in VLNT group had statistically significant difference than that (from 3.0 ± 1.4 to 5.0 ± 2.4, p=0.07) in LVA group. Both VLNT and LVA surgeries can effectively treat primary lymphedema patients. The reduction of above-knee circumference, body weight, episodes of cellulitis, and the improvement of LYMQoL was significantly greater in LVNT compared to LVA. All of the patients did not use compression garments post-operatively! 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. Recommended reading journal Vascularized lymph node flap transfer and lymphovenous anastomosis for klippel-trenaunay syndrome with congenital lymphedema. Qiu SS, Chen HY, Cheng MH. Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e167. https://www.ncbi.nlm.nih.gov/pubmed/25289360 Successful Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema. Charles, 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

Am I A Candidate? 我適合什麼手術？淋巴水腫手術的適合對象、不同治療方案和術後注意事項 Am I A Candidate? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Suggested Candidates For Lymphedema Surgery A full medical history and thorough physical exam are required for the initial clinic visit. The circumferential differentiation between the affected and unaffected limbs (in unilateral disease) will be the focus, and measured comprehensively during the physical exam. Who is eligible for lymphedema surgery? A complete history, complete examination and diagnosis of both the lymphedematous limb and the unaffected limb (unilateral disease) are required at the initial visit. Based on the research results, Dr. Cheng's lymphedema grading system can establish a diagnosis and formulate treatment plans for patients. 1 Suggested candidates for Lymphedema surgery are as follows: Lymphedema patients who aggressively receive rehabilitation for more than 6 months without significant improvement. Lymphatic obstruction present in lymphoscintigraphy. The difference of circumference between the affected and non-affected limbs is more than 10%. Cancer patients with the aforementioned indications without tumor recurrence or distant metastasis. Learn more 2 Indications for Vascularized Lymph Node Flap Transfer are as follows: Patients exhibiting a total obstruction on lymphoscintigraphy in late grade II, grade III, and IV. Patients without patent lymphatic ducts on indocyanine green lymphography. Learn more 3 Indications for Lymphovenous Anastomoses are as follows: 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 Lymphedema Treatment Options Accurate diagnosis and appropriate staging assessment are fundamental to the successful treatment of lymphedema. The conventional treatment methods often require the use of antibiotics, massage, and complex decongestive therapy including compression garments and bandages. Innovative surgical treatments have been emerging rapidly in the past 10 years, and the ground breaking vascularized submental lymph node (VSLN) or vascularized groin lymph node (VGLN) flap transfer to distal recipient site that invented by Dr. Cheng create a natural physiologic drainage conduit to alter excess lymphatic fluid buildup and revert side effects like those of tissue fibrosis and skin swelling. Dr. Cheng’s surgical treatment outcomes show significant improvements in the circumferential reduction rates of the affected limb circumference without the use of compression garments. Data source: Asuncion M, Cheng MH, et al. PRS Global Open. 2018;23;6(3):e1691. Cheng MH, et al. Plast. Reconstr. Surg. 2013;131(6):1286-98. 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 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. 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

Primary Lymphedema 淋巴管靜脈吻合術：​安德森的專業技術， 您的安心選擇及​案例分享 Delayed Reconstruction Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Treatment Instructions Delayed breast reconstruction refers to a situation where breast cancer patients do not choose to undergo breast reconstruction at the time of mastectomy, or they miss the opportunity for immediate reconstruction due to a lack of information. Some patients may temporarily decline reconstruction surgery due to fear of cancer, concerns about the success rate of the surgery, or other reasons. After completing breast cancer treatment, including chemotherapy and/or radiation therapy, they undergo breast reconstruction at a later time. This second surgery is known as delayed breast reconstruction. Regain beauty and confidence. DIEP Flap (1) DIEP Flap (2) 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. Is delayed reconstruction more difficult? Delayed breast reconstruction is slightly more challenging compared to immediate breast reconstruction. Factors such as insufficient skin, scar tissue from previous surgery, and underarm depressions after lymph node clearance are additional considerations. First, during a total mastectomy, if immediate reconstruction is not planned, the breast surgeon will remove excess skin and close the wound with a straight line. Therefore, in autologous tissue breast reconstruction, not only is fat from areas like the abdomen, back, buttocks, or thighs important, but the skin covering the area is also crucial. If the patient opts for implant reconstruction or desires scar placement similar to immediate reconstruction (limited to a smaller area), an additional step is required: inserting a tissue expander to stretch the skin. The second challenge is the scar tissue adhesions or fibrosis within the entire chest area. During the reconstruction surgery, the surgeon must carefully release these scars to create a well-shaped breast. The third issue is the noticeable depression in the underarm, caused by the removal of most lymph nodes. If this depression can be filled during reconstruction, the result will be much more satisfying, particularly improving clothing options and comfort, especially in summer. Another technical challenge arises with free flap breast reconstruction. The surgeon must find a healthy set of blood vessels in the chest to supply blood to the flap. In delayed reconstruction, the thoracodorsal artery may sometimes be unusable due to damage from the first surgery or because severe scarring makes dissection difficult. However, this issue is not the most difficult for experienced surgeons. Most skilled and up-to-date surgeons now use the internal mammary vessels for anastomosis. Although the internal mammary technique is more complex than using the thoracodorsal artery and less experienced surgeons may be hesitant to use it, it yields better results. The fat in the flap survives well due to the abundant blood supply. While delayed reconstruction presents certain challenges, these can be overcome by experienced surgeons. Delayed breast reconstruction can still achieve a natural and beautiful result, making it a highly recommended procedure. Breast cancer survival rates have significantly improved, and we sincerely believe that patients should not have to endure ongoing inconvenience or lifelong feelings of loss and regret due to the absence of a breast. When can delayed reconstruction be done? According to research from the world’s leading cancer hospitals, it is now widely accepted that breast reconstruction can be performed at the same time as mastectomy without increasing the risk of breast cancer recurrence or interfering with the detection of any potential recurrence. As a result, this is not just a trend but the reason why every breast cancer patient, once diagnosed, is immediately referred to a plastic surgeon to discuss reconstruction options. Therefore, the best time for breast reconstruction is whenever the patient expresses a desire to undergo the procedure. In the past, doctors used to advise patients not to undergo reconstruction within two years of a mastectomy, as most breast cancer recurrences happen within this period. However, in recent years, this restriction has been lifted. In Taiwan, particularly at Chang Gung Memorial Hospital, the recurrence rate is 4-5%, while in the U.S. it is 2-3%. Considering the 4-5% recurrence rate versus the 95% of patients whose quality of life and psychological well-being can be improved, such advice now seems unreasonable and unfair. Helping patients feel truly free from breast cancer as soon as possible is the greatest mission and source of fulfillment for reconstructive surgeons. The current consensus is that if chemotherapy or radiation therapy is required after mastectomy, breast reconstruction can be done once these treatments are completed. It is generally recommended to wait about one month after chemotherapy and 3 to 6 months after radiation therapy before proceeding with breast reconstruction surgery. 01 第一階段：植入組織擴張器，將其撐大至需要放植入物的大小 圖一、組織擴張器 02 第二階段：移除組織擴張器，更換植入物（矽膠袋或生理食鹽水袋） 平滑面義乳 絨毛面義乳 香榭柔滴 Sebbin 曼陀女王波 Mentor 魔滴 Motiva 珍珠波 / 盈波 Impleo 香榭柔滴 Sebbin Sebbin總部位於美學流行之都巴黎，是歐洲領先擁有35年製造醫療植入物的製造商，目前臨床已發表超過20篇國際期刊及10年追蹤報告。並提供10年安心保固服務。 香樹柔滴隆乳的觸感是否自然？像真實的胸部嗎？ Sebbin 的乳房植體在硬度上、形狀、尺寸上有多種不同的選項，種類包含光滑的圓形植體、微紋理的圓形植體、解剖結構式的植體，可依據不同胸型提供不同選擇，採用極柔軟的觸感－Nanoskin科技，如同真實胸部的軟組織般柔軟自然。隆乳時使用FDA認證廠商出產的材料，更能確保身體的健康及安全。 義乳內建識別碼，術後可追蹤品質 香榭柔滴Sublimity的微紋理圓形植體，除了為極高黏性材質且更為柔軟之外，每個植體皆帶有可識別的激光碼，可以用來追蹤植入物的信息。此編號位於植體隨附的標籤上，手術後會記錄在病患的病歷卡上。 臨床手術追蹤10年後，只有不到1%的手術者表示義乳有產生破裂或莢膜攣縮的症狀。這也證實了香榭柔滴Sublimity發生莢膜攣縮的機率極低，特殊的微紋理材質確實降低了攣縮機率。 ※ 擁有10年安心保固服務 曼陀女王波 Mentor 曼陀女王波Mentor公司新推出的光滑面果凍義乳，是通過美國FDA核可的品牌，屬於特殊的增高型義乳（Ｍentor Xtra），義乳底盤較窄，增加了整體的凸度，對身體較瘦、胸廓較窄、骨架小的亞洲女性來說，想要高挺的胸型，「女王波」是一個不錯的考慮。 女王波的膠體填充率接近100%， 採用Ai精準填充技術，觸感較柔軟，近乎飽滿的填充率，具有高度的支撐力，能打造更立體的弧形。 女王波的外膜擁有「三層矽膠外膜」，經測試擁有高達7倍的延長力，即使受到強力撞擊也能迅速恢復。強韌的外膜加上高塑形能量，經過長達10年統計，女王波發生莢膜攣縮的機率小於1%，能有效抵抗莢膜攣縮反應。 ※ 擁有12年安心保固服務 魔滴 Motiva 魔滴（Motiva）採用美國 FDA 核准用於人體的微型安全晶片，直徑小於米粒，必要時醫療團隊可使用專屬掃描器查詢乳房植入物的資訊，方便追蹤。 Motiva®外層材質稱之為SilkSurface奈米絲綢外層膜，有別於傳統光滑面及絨毛面，具有高度延展特性，讓醫師可以使用較小的手術切口就能植入義乳。 義乳內容物為100%無空隙填充，觸感較Ｑ彈一點，研究報告指出所有不良反應發生率< 1%（包含莢膜攣縮與植入物破裂）。 ※ 擁有10年安心保固服務 珍珠波 / 盈波 Impleo 珍珠波是由英國具有40年歷史知名品牌 GC Aesthetics®所生產的 光滑霧面 果凍矽膠，盈波IMPLEO 則是 光滑表面 的果凍矽膠。 GC Aesthetics®是一家擁有40年經驗豐富的全球醫療技術公司，具有美容和重建手術產品，目前在全球70個國家與地區銷售超過300萬個以上隆乳植入 物，經過長期臨床數據驗證,是有一定安全性及臨床實證，擁有歐盟CE及台灣 TFDA 雙證核可，植體保障安心，獲得高度信賴隆乳品牌。 「珍珠波」優勢 採用 BioQ™ Surface 專利珍珠表面,假體外殼薄但堅固,呈現更自然的外觀及增加柔軟觸感，獨特霧光面提高生物相容性，降低潛在性感染風險。 來自珍珠波 Emunomic™第六代珍珠凝膠，採用高強度之凝膠，可有效減少破裂風險，因具有出色形狀穩定性，能夠適應不同體型需求，同時保持乳房的自然曲線。 Ultra-linkTM外殼具有高強度延展性及抗裂性，能夠承受高度的壓縮性，可確保植入物在各種情況下及長期使用都不易變形及失去形狀。 「盈波」優勢 與珍珠波不同處為表面光滑之矽膠材質,猶如真乳自然動態感,使觸感更加柔軟，在韓國市場中，盈波為隆乳手術熱銷產品之一。 外層採用 Nagotex 專利技術，有效增加組織附著，減少假體旋轉、位移及膜攣縮等問題。 歐盟認證2S強韌流動膠體：100%填充並結合 SiloGard 保護屏障，避免膠體擴 散與水波紋產生。 盈波有長達15年臨床追蹤數據，已經歷多年時間考驗，可提升使用者安心感。 乳型定位不走山：「義乳按摩+彈性繃帶」一定要學會 平滑面的植入物必須定時按摩，每日按摩3次，1次10至15分鐘，將植入物往內、上、左、右等不同方向按摩運動，要按照醫師及治療師個別評估指導的 按摩方式為佳，按摩至少需要3∼6個月。也可以採用綁彈繃方式，每日約綁2個小時即可放鬆，1天可綁一至二1-2次，以及睡前可以趴睡的姿勢（術後滿1個月再執行）約15分鐘即可，以維持植入物空間的穩定。 What methods can be used for delayed breast reconstruction? The first method we need to mention is using implants, which can be saline or silicone gel implants. As previously mentioned, in delayed breast reconstruction, there is typically insufficient skin on the chest. Therefore, if implants are used for reconstruction, a tissue expander will be needed as a transitional phase. As the name suggests, a tissue expander is used to stretch the skin or tissue. It requires an initial surgery to place the expander under the skin. Typically, the skin is expanded to be slightly larger than the other breast. After about three months, once the skin has stabilized, a second surgery is performed to remove the expander and replace it with a permanent implant. The second method involves using local autologous tissue or performing breast reconstruction surgery with a free flap. The most suitable methods for breast reconstruction after radiation therapy. If a patient has received radiation therapy, it is not recommended to use only tissue expanders and implants for reconstruction. This is because radiation therapy can cause fibrosis of the skin on the chest, which not only increases the risk of capsular contracture leading to a poor aesthetic outcome but also makes the skin more susceptible to poor wound healing and exposure of the implant. If autologous tissue is insufficient and the patient must choose implant reconstruction, it is recommended that the patient select a latissimus dorsi flap combined with an implant for reconstruction to achieve a result that is both aesthetically pleasing and safe. 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

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

Primary Lymphedema 淋巴管靜脈吻合術：​安德森的專業技術， 您的安心選擇及​案例分享 Lymphovenous Anatomosis (LVA) Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema A common problem cancer survivors face is post-operative lymphedema. Lymphedema is caused by excess fluid that collects in the body’s tissue, causing swelling (edema). The symptoms are typically swollen limbs due to lymphatic circulation blockage. Some patients may also experience skin problems (eczema, rough skin, unidentified protrusion), repeated cellulitis or toe mold infection. Award winning plastic surgeon Dr. Cheng specializes in reconstructive surgery and is an expert in the lymphovenous anatomosis (LVA) technique, a minimally-invasive microsurgery procedure that can address the symptoms of lymphedema. Since lymphedema is not always treatable with non-surgical rehabilitation, LVA surgery can greatly improve the condition. 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 57-year-old female with left upper limb lymphedema for 12- months Before Surgery: This is a 57-year-old female with left upper limb lymphedema for 12- months after left mastectomy and radiation. After Surgery: 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. 56-year-old female with right upper limb lymphedema for 10- months Before Surgery: 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. After Surgery: 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. 39-year-old female with left upper limb lymphedema for 6- months 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. Before Surgery: 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. After Surgery: 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. 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. Candidates for LVA Cancer patients that have had lymph nodes removed due to the disease Patients who have not experienced relief from non-surgical therapies Cheng’s grading I, and early grade II lymphedema Partial obstruction on lymphoscintigraphy Patent lymphatic ducts on ICG lymphography Determining a Treatment Plan For patients with grade I to IV lymphedema, an individualized treatment plan is determined based on imaging studies. Patients with grade I and early II lymphedema will undergo a lymphodynamic evaluation by indocyanine green (ICG) lymphography. The ICG injection allows Dr. Cheng to evaluate the presence and location of open, functioning lymphatic channels or dermal backflow (obstruction of lymphatic flow). This type of image study is performed via injections into the second and fourth web spaces of the fingers or toes. Images are obtained at 5 minutes, and then again after 20 hours. These image studies enable Dr. Cheng to create a customized treatment plan for each patient depending on their degree of lymphedema. How Does LVA Surgery Work? The most advanced, minimally invasive super-microsurgical techniques relieve lymphedema through small incisions (around 3cm). Preoperatively, ICG lymphography is used to map the lymphatic system on the skin and locate the incisions. Once the lymphatic channel and a suitable vein have been identified and prepared, a connection between them is created to give the lymphatic fluid an alternative route to escape from the affected area. The lymph fluid will then drain effectively through the vein. Surgical Techniques If LVA surgery is chosen for a patient, Dr. Cheng’s preference is to perform one or two Side-To-End (lymph-to-vein) anastomosis. Using super-microsurgery techniques, Dr. Cheng performs the LVA surgery so that the lymph can drain into the vein from both proximal and distal directions. Into the planned incision, allowing the lymphatic channels to be easily detected. The can then be seen draining from the lymphatic channel into the vein, confirming LVA surgery success. ICG fluorescence may also be used to verify a successful LVA surgery. Side-to-end (Cheng’s Technique) End-to-end (Koshima’s Technique) End-to-end (A and B) end-to-side (C and D) anastomosis are shown. The decision to perform one versus another is based on the intrinsic functionality of the native lymphatic and the inherent pumping mechanism. If the venous pressure is greater than the lymphatic pressure, the blood is regurgitated and causes the anastomosis thrombosis (B and D). Bidirectional lymph will flow into the vein in a side-to-end fashion (C and 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 63. Patency test of the side-to-end lymphovenous anastomosis using indocyanine green lymphography (right) and patent blue (left) Q1 What does the lymphatic system do? The lymphatic system is vital to ensure a healthy body. It is responsible for circulating protein-rich lymph fluid though the body. During this process, it collects bacteria, viruses and waste. The fluid gets carried through the lymph vessels to the lymph nodes where the waste is filtered out by infection-fighting cells. The lymphatic system is part of the body's immune system and a crucial aspect of a person's health. Q2 What are the causes of lymphedema? Lymphedema occurs when your lymphatic system is unable to properly drain lymph fluid. While primary lymphedema occurs on its own, secondary lymphedema, which is more common, is caused by a disease or condition. Secondary lymphedema is usually seen when the lymph nodes are removed, oftentimes as part of a cancer treatment. Lymphedema can also be caused by damage to the lymph nodes, from radiation treatment or infection. Should there be a blockage in the lymphatic system, the lymph fluid will not drain well. This leads to fluid buildup and swelling, which generally occurs in the arms and legs. Q3 How can LVA surgery improve lymphedema? LVA surgical approaches, like Dr. Cheng's advanced LVA technique, are effective in reducing or eliminating lymphedema swelling and discomfort. The LVA method directly connects the lymphatic vessels in the affected area to nearby veins. This allows the built-up lymph fluid to drain, which improves the fluid circulation in the body. Typically, LVA is an outpatient procedure, with most patients returning home the same day as the surgery. 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

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. Miffy Chia-Yu Lin Miffy Chia-Yu Lin, a Ph.D., is the lymphedema coordinator at the Center of Lymphedema Microsurgery. She is the contact person for patients to book consultations with Dr. Cheng. She can be contacted by phone, email, or WhatsApp. She is extremely knowledgeable in treating lymphedema patients and committed to strive for the continuous improvement of lymphedema care and treatment. She has been working at the center for over a decade. She is also a member of the Sigma Theta Tau International Honor Society of Nursing. A+ Surgery Clinic offers: Primary lymphedema Upper limb lymphedema following breast cancer treatment Lower limb lymphedema following gynecological cancer treatment Lower lymphedema presented after trauma or other surgeries

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 / Item Title Describe the item and include any relevant details. Click to edit the text.

揮別壓力衣！鄭教授的獨門顯微手術，改善淋巴水腫帶來的不適，了解不同淋巴水腫治療方式的比較及安德森的專業

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