在安德森內搜尋：

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

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. 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. Transitional period before breast reconstruction: How to buy and choose a breast prosthesis bra? After undergoing a mastectomy, especially for patients who will have delayed breast reconstruction, there will be a period when they cannot wear regular bras. To consider physical balance and appearance when dressing, it is likely necessary to wear a specially designed prosthesis bra. Since a prosthesis is an "external object," even though current technology has improved its quality, it still tends to be heavy and may not fit snugly against the body, making it difficult to balance the weight on one side. Therefore, this is not a long-term solution, and it is advisable for patients to discuss the timing of breast reconstruction with their doctor to address the fundamental issue. The options for purchasing a prosthesis bra are not widespread, as they are produced by specialized manufacturers, some of which offer custom-fitting prosthesis pads and replacement services. Patients can seek professional information and recommendations on selection from their breast surgeon or plastic reconstructive surgeon and nurses. Considerations for Choosing Styles: Style Selection: Avoid styles that may rub against the surgical wounds (e.g., if lymph node clearance was performed under the arm, the opening in the bra under the arm should be slightly lower). Deep Pocket for Padding: The inner pocket for the prosthesis should be deep enough to prevent the padding from sliding out during movement. Wide Shoulder Straps and Supportive Band: This design can help reduce the burden on the shoulders. Higher Coverage at the Front: This helps prevent the prosthesis from slipping out and becoming exposed. Back Closure Design: Avoid frequent friction and pressure on the scar, which can cause pain and tissue hypertrophy. Good Fabric Elasticity: The material should be stretchy enough to conform to the body’s curves. 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

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

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

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

鳳凰電波特色、探頭比較 ｜需要幾次療程？｜鳳凰電波與電波的差異｜術後保養和注意事項 ｜ 立即預約 與我們聯絡 HELIOS II 8倍淨膚雷射 Helios II 特色 由全世界頂尖光學領域的科學家研發而成，治療以溫和、低痛感受到大眾喜愛 HELIOS II 8倍淨膚會產生光震波及光熱效應，光震波效應藉由1064nm及532nm兩種波長對皮膚不同的穿透深度，可有效破壞淺層及深層的黑色素，而光熱效應可抑制皮脂分泌，促進膠原蛋白新生。 分段光束模式 Virtue 1 提高8倍效能 穿透力更強 除斑更徹底 Virtue 2 分段光束模式 雷射能量更均勻 有效縮短治療時間 Virtue 3 世界級專利低溫淨膚探頭 表皮層易累積過高熱能 可降低術後返黑機率 Virtue 4 特殊1064nm雷射波長 重建膠原蛋白結構 恢復肌膚彈性 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. 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. 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. 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. 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.

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

為維護良好的醫療品質與看診舒適，本院採預約制，您可先以電話、電子郵件、LINE或填寫線上表單等方式預約，我們會盡快與您聯繫！ Let's Connect How to Make an Appointment? To ensure high-quality medical care and a comfortable consultation experience, our clinic operates on an appointment-only basis. You can schedule an appointment via phone, email, LINE, or by filling out the online form. We will contact you as soon as possible! Business Hours: Monday to Friday, 8:00 AM to 6:00 PM. Closed on weekends. Notice Please download and complete the Client Information Form from our website. The information you provide will allow the A+ Surgery Clinic to select the most suitable team of specialists to assist you with your medical or personal needs. On the form, please clearly specify your preferred appointment dates as well as any special requests or personal needs that you may have. We will try our best to make you feel as close to home as possible. Please provide all detailed medical reports at least from the past 3 months, including lab or pathology reports and imaging files (X-rays, CT, MRI, Ultrasounds, Lymphoscintigraphy, etc.). If you have medical information, please provide it. Please send (1) and (2)to A+ surgery clinic at aplussurgery@gmail.com and Miffy Lin. Within two business days, A+ surgery clinic or Miffy Lin will contact you by email with further appointment details or medical questions once we receive and review your application form. Any information you provide will be kept strictly confidential under the Medical and Personal Data Protection Laws in Taiwan. Treatment Plan After gaining understanding of your medical background, our medical team will draft and present to you a treatment schedule specifically tailored to your personal needs. At the same time, a detailed statement describing the treatment process and estimated costs will be sent to you by email. Appointment Confirmation Once you have confirmed and accepted Dr. Cheng’s treatment plan, your medical coordinator will proceed to set up, double check, and confirm your previously made appointment date, as well as make the necessary travel visa preparations, airport pickup, and hotel accommodations for you, to make your stay with us carefree. Address 3rd Floor, No. 337, Fuxing North Road, Songshan District, Taipei City (MRT Zhongshan Junior High School Station) Map Phone (+886) 02-2712-3373 Phone (+886) 0966-523-737 Phone Email care@aplussurgery.com Social Media LINE Name Gender * Male Female Other Email Region * Taiwan Others Phone Convenient contact time 選擇一個時段 Remark Send Appointment successful ！

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

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