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Lower Extremity Lymphedema 下肢淋巴水腫：成因與症狀、淋巴水腫診斷、治療方式 What is Lymphedema of The Legs? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lower Extremity Lymphedema? The lower extremity lymphedema has a 10-49% occurrence in patients who suffer from gynecological cancers with pelvic lymph node dissection and radiation. Higher body mass index, a greater number of pelvic lymph node removal, and radiation are the top risk factors for lower extremity lymphedema caused by parasite infection (Filariasis). Primary lymphedema patients with unknown etiology for symptoms and signs are categorized by their ages of onset as congenital (less than 2 years), lymphedema praecox (2- 35 years), and lymphedema tadar (older than 35 years). The incidence is higher after cancer resection and lymph node dissection in vulva cancer followed by cervical and ovarian cancer. Recently, sentinel lymph node biopsy was selectively applied in gynecological cancer surgery to reduce the lower limb lymphedema. Symptoms of Leg Lymphedema Lymphedema then presents as chronic changes and swelling of the tissue and is often associated with adipogenesis or fibrotic changes in the lower limb as well. 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. It is common for lymphedema patients to experience depression, due to the physical discomfort, emotional distress and lowered quality of life. Diagnosis of Leg Lymphedema Dr. Ming-Huei Cheng developed a Cheng’s Lymphedema Grading tool to assess the severity of extremity lymphedema. Cheng Lymphedema Grading System is currently the most common used measurement, it is based on not only subjective criteria and clear objective findings that could facilitate discussions and meaningful comparison of the treatment proposed. The circumferential measurement is an objective analysis tool to assess the severity of lymphedema commonly by comparing the circumferential differences between the lymphedematous limb and the normal limb. Lymphoscintigraphy, computed tomography (CT), indocyanine green (ICG) lymphography, and magnetic resonance imaging (MRI) are other key diagnostic devices to determine the severity of lymphedema. The lymphoscintigraphy has been reported as the most effective indicator with 96% sensitive and 100% specific conclusion for diagnosing extremity lymphedema. The Taiwan Lymphoscintigraphy Staging systems was published in 2018 at Annals of Surgery. Lymphoscintigraphy computed tomography (CT) magnetic resonance imaging (MRI) indocyanine green (ICG) lymphography Treatment of Lower Extremity Treatments of lymphedema are aimed to control infection, to reduce the swelling of the extremity and to improve the quality of life. Basic treatments of lymphedema start with conservative physical therapy, including manual lymphatic drainage and compression bandage-centered decongestive lymphatic therapy. The efficacy of conservative physical therapy presents only when the patients are compliant with the treatment program. However, it also carries risks of intravascular cancer metastasis and thrombosis formation. Surgical treatments are indicated when first line conservative measures fail and when patients present with late stage disease. There are two main categories of surgical treatment: excisional and physiologic procedures. Excisional procedures are essentially a surgical reduction of excess fibro-adipose tissue in the affected limb while physiologic procedures reconstruct the lymphatic system to improve physiologic drainage. Surgical treatments are also “be cure and control”, the goals of treatment are similarly preventing progression of disease and reducing morbidities. Debulky surgery and circumferential suction-assisted lipectomy can be performed to reduce the severely, non-pitting lymphedematous extremity. More technical demanding surgeries, such as lymphaticovenous anastomosis and Free vascularized lymph node transfer The basic physiologic mechanism of the vascularized lymph node flap is that lymph is absorbed by the transferred lymph nodes and drained into a donor vein through natural lymphaticovenous connections inside a flap. The arterial flow from the recipient artery to the vascularized lymph node flap provides the driving force for venous return and hence, continuous lymph drainage. We report the transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumfer- ence was 64±11.5% above the knee, 63.7±34.3% below the knee and 67.3±19.2% above the ankle. 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 A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Cheng MH, Huang JJ, Nguyen DH, Saint-Cyr M, Zenn MR, Tan BK, Lee CL. Gynecol Oncol. 2012 Jul;126(1):93-8. https://www.ncbi.nlm.nih.gov/pubmed/22516659 Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure. Ito R, Lin MC, Cheng MH. Plast Reconstr Surg Glob Open. 2015 Sep 15;3(9):e513. https://www.ncbi.nlm.nih.gov/pubmed/26495226 Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes. Pappalardo M, Patel K, Cheng MH. J Surg Oncol. 2018 Jun;117(7):1420-1431. https://www.ncbi.nlm.nih.gov/pubmed/29572824 Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema. Gustafsson J, Chu SY, Chan WH, Cheng MH. Plast Reconstr Surg. 2018 Jul 10. https://www.ncbi.nlm.nih.gov/pubmed/30020232 Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

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

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. 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 aplussurgery@gmail.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 ！

Advanced Diagnostic Technology 淋巴管攝影檢查： 循血綠 Indocyanine Green（ICG）淋巴管攝影、ADRONIC ICG 螢光攝影機、Mitaka顯微鏡 Advanced Diagnostic Technology Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Indocyanine Green (ICG) Lymphography Indocyanine green (ICG) is a green colored dye. It binds to albumin (a kind of protein), which is transported within the lymph fluid. ICG has been used to test blood flow after being injected intravenously and has also been used to show lymphatics after low dose injection to the subcutaneous tissue. ICG lymphography uses a specialist infra-red camera to detect low dose injected ICG dye in the subcutaneous tissue with the depth of 10 mm. The lymphatic function can be checked on a screen during the scan. What does ICG lymphography image look like? Normal function of lymphatic system: After ICG is injected, it will quickly be taken by the lymphatics and transported in the lymphatic tubular duct as a linear lymphatic vessel (linear fluorescence). When functioning normally, the fluid and dye will rhythmically push up the lymph proximally. In lymphedema limb: In lymphedema limb, the one-way perfusion may be stuck. The lymphatic fluid remains in lymphatics, and the structure of the lymphatic duct will gradually be dilated, fibrotic then obstructed. As lymphedema progresses, the fluid will leak into subcutaneous tissue, causing dermal backflow (star-like fluorescence). ”ADRONIC” ICG “ADRONIC” Fluorescence Imaging System is a fluorescent image photography device, so that the surgeon can shoot, review, store high-quality fluorescent image device. “ADRONIC” Fluorescence Imaging System is used with fluorescent developer “Indocyanine Green” (Indocyanine Green). Including lymphatic vessels and blood vessels, as well as related applications during a variety of surgical procedures. Infrared transmitter can be controlled by the professional staff to adjust the distance or set up in the top of the camera to facilitate the operation, video recording can be immediately after the completion of the replay to review. Model: Adronic ICG Independent imaging with 3.5 inch screen Able to snapshot and record video Provides doctors with accurate location of vessel and lymph Case Sharing Breast cancer is a very common malignant tumor that women often experience. The number of cases is increasing over the years. In addition, it can seriously threaten women’s physical and mental health. Surgery and operation are still the common treatment that doctors use. However, it can cause detrimental complications to the human body. For example, upper limb lymphedema, bring great pain to the patient and seriously affects the quality of life of the patient. Doctor Cheng Ming-Huei, authority in plastic surgeon and ex-director of A+ Surgery Clinic, metioned that the fluorescence spectrum lymphangiography of ICG Video Scope can be used in breast cancer, breast augmentation and breast reduction. It brings applications to future clinical studies and reduces the recovery time needed after surgery. It also avoids the waste of medical resources due to the lower possibility of relapse. Features of ICG Video Scope Monitors edema of lymph in flaps Monitors the Lymphatic reconstruction and the recanalization Distinguishes different lymph drainage of breast and upper limb to decrease the possibility of Lymphedema after surgery Monitors the different pathological changes of muscle by the patients with Lymphedema The Fluorescence Imagining system is highly sensitive and provides reliability to the examination of Vessel Lymphedema Mitaka Microscope & Zeiss Pentero 900-Microscope The Mitaka Surgical Microscope is high resolution at 160 line-pairs per millimeter and 42x, making it ideal for working in the sub-1mm environment. Spy Elite SPY Elite, a fluorescent imaging system, may be used by surgeons to help determine whether certain tissues in the body have a strong enough blood supply for transplant purposes. Analyzing the blood circulation of tissues throughout the body may help our surgeons identify healthy donor tissue that may be harvested for such purposes, or compare the viability of various donor sites they are considering.

鄭明輝院長投入內視鏡乳房重建領域20多年，至今已幫助超過1000多名失去乳房的女性重建乳房、找回自信。 台灣的乳癌患者切除乳房後，有1/4罹患憂鬱症，感謝勇敢的乳癌姐妹們，給自己一次機會找回人生希望，希望透過她們的分享，鼓勵乳癌姊妹們勇敢重建。 五星好評推薦 感謝每一位來到安德森的朋友 你們的回饋是我們前進的動力，我們會持續將最好的醫療服務帶給各位 素人美麗見證 選擇安德森後，她們都重新蛻變 希望與大家分享這份喜悅 隆乳＋縮乳頭 案例分享 從小就是個小胸人，一直到懷孕哺乳，才體會到什麼叫胸🤣。 產後為了減肥，把剩餘僅存的胸(脂肪)都減掉了(哭哭)。 看著自己的身材慘不忍睹，進而開始尋求中醫豐胸，花了不少錢。 精神睡眠是有好一點，但胸部一點進展都沒有😭。 意外從網路得知一些隆乳的資訊，就開始做些功課。 除了上網查些相關資料，還有Line的社群可以詢問。 從開始諮詢到決定手術時間很快，因為我怕我後悔就不敢做了 既然有想法就趕快速速決定。 預防性切除＋義乳重建案例分享 18歲時知道自己有BRCA1,就一直周旋醫院 每年都要去和信治癌中心追蹤 照波 粗針切片 這一來一回的好多年就這樣過去 原本其實一直想著40歲再切除 隆乳案例分享 鄭教授的淋巴顯微手術，術後不需再穿壓力衣 淋巴水腫案例分享 自然、永久、美觀，健康窈窕再現 乳房重建案例分享

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 Congenital Breast Deficiency Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Treatment Instructions What Is Poland Syndrome? Poland Syndrome was first described in 1841 by Dr. Alfred Poland, who identified patients with an absence of the pectoralis major muscle. This syndrome is characterized by partial or complete underdevelopment of the pectoralis major muscle, often accompanied by other abnormalities on the same side, such as syndactyly (webbed fingers), digit deformities, and underdeveloped breasts. The severity of the condition can range from mild to severe and may also involve the serratus anterior, latissimus dorsi, or other muscles, as well as flattened or partially absent ribs. In some cases, it is associated with chest deformities like pectus carinatum (pigeon chest), pectus excavatum (funnel chest), or scoliosis. The incidence of Poland Syndrome in international studies is reported to be approximately 1 in 10,000 to 100,000 live births. It is twice as likely to affect the right side compared to the left, and it occurs equally in males and females. However, female patients are more likely to seek breast reconstruction from plastic surgeons. The exact cause of Poland Syndrome remains unclear. Hypotheses include abnormal vascular development, trauma during development, or genetic factors, but no definitive explanation has been established. 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. Breast Reconstruction: Improving Appearance and Addressing Complications Most patients with Poland Syndrome do not experience significant functional impairments, and hand deformities are often mild. Diagnosis involves taking a detailed medical history, including prenatal history, and performing a physical examination of the chest, shoulder, and hands. Serum immunological tests may be conducted to rule out other conditions. For patients with underdeveloped ribs, a chest CT scan is recommended. Reconstruction treatments include the following methods: Implant-Based Reconstruction The earliest treatment for congenital breast deficiency involved the use of implants, such as silicone or saline. However, the results were often suboptimal. The absence of the pectoralis major muscle frequently leads to capsular contracture, resulting in a tight, unnatural breast shape. Tissue Expander Reconstruction Another approach is to first insert a tissue expander, gradually inflating it with saline over 2-3 months to stretch the skin and create space. The expander is then replaced with a permanent implant, resulting in a more natural breast shape. However, there is still a risk of capsular contracture with this method. Autologous Tissue Flap Transfer The latissimus dorsi flap can be used for reconstruction, but in some Poland Syndrome patients, this muscle may also be underdeveloped, and its fat content may be insufficient. In such cases, an implant is often required to achieve the desired volume. Additionally, the latissimus dorsi muscle may feel firmer than natural breast tissue. Autologous Fat Transfer Using a DIEP (deep inferior epigastric perforator) flap, which transfers abdominal fat along with its nutrient blood vessels, offers a more natural result. This method avoids sacrificing the rectus abdominis muscle, is less painful, and provides permanent, soft, and natural breasts. This approach yields the highest patient satisfaction. 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 Contact us 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. 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 aplussurgery@gmail.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 ！

​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：​鄭明輝教授團隊、認識與診斷淋巴水腫和手術治療方案 Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 1 DR. CHENG The Journey of Dr.Cheng Dr. Cheng's Team Publications Presentations Visiting Professorships Awards News 2 PROCEDURES What is Lymphedema? Upper Extremity Lymphedema Lower Extremity Lymphedema Primary Lymphedema Diagnosis of Lymphedema Advanced Diagnostic Technology WSLS 2024 3 CENTER Treatment Comparison Chart Am I A Candidate? Lymphovenous Anatomosis Vascularized Lymph Node Flap Transfer Cheng Lymphedema Grading Systems Lymphedema FAQ Videos 4 GALLERY Mild to Moderate Lymphedema Severe Lymphede Patient's Testimonials Post-Operative Care 5 PATIENT INFORMATION Make an Appointment Accommodation Information Travel Information Patient Rights About Lymphedema Microsurgery Dr. Cheng has been practicing Lymphedema microsurgery since 2000. He has invented some of the most advanced and effective surgical techniques to treat lymphedema. His ground-breaking innovation of vascularized submental lymph node (VSLN) and vascularized groin lymph node (VGLN) flap transfer to distal recipient site creates a physiologic drainage conduit to alter excess lymphatic fluid buildup and minimize the lymphedema associated side effects of tissue fibrosis and cellulitis. Dr. Cheng's lymphedema microsurgery outcomes show statistically significant circumferential reduction rates of affected limb circumference and impressive decreases in the episodes of cellulitis on the lymphedematous limb. His practice is the first in the world to immediately release patients from wearing compression garments postoperatively. Meet Dr. Cheng Ming-Huei Cheng MD, MBA, FACS, is a board certified plastic surgeon specialized in reconstructive microsurgery. Dr. Ming-Huei Cheng is listed among the most sought-after surgeons in the reconstructive microsurgery field. He has performed more than 2,000 microsurgical cases, including arm and leg reconstructions, head and neck reconstructions, breast reconstructions, extracranial-intracranial arterial bypasses, lymphovenous anastomosis and vascularized lymph node flap transfers. He finished a combined microsurgical and research fellow at Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Texas in 1999. He is a member of the American Society for Reconstructive Microsurgery since 2003, a fellow of the American College of Surgeons since 2009, an international member of the American Society of Plastic Surgeons since 2012 and became an Adjunct Professor of the Department of Plastic Surgery at University of Michigan, USA in 2017. Learn more Dr. Cheng is Affiliated With 鄭教授淋巴水腫顯微外科手術學術里程碑 Dr.Cheng’s Academic Journey for Lymphedema Microsurgery 出處：取自《乳癌奇蹟治癒》方舟出版社 News We appreciate the recognition and affirmation from our patients in the United States. Every word of encouragement is our driving force! Dec 17, 2024 Professor Cheng was invited to attend the 49th Global Plastic Surgery Conference held in Porto, Portugal. Dec 10, 2024 Gratitude from Canada — A Patient's Kindness Warms Our Hearts Sep 26, 2024 1 2 3 4

GALLERY 2013 2016 2019