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

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

瞭解更多手臂淋巴水腫的成因及症狀，以及為何安德森整形外科是您的安心選擇，有任何問題歡迎電話及線上諮詢。 Upper Extremity Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery What Is Upper Extremity Lymphedema? Breast cancer patients who underwent axillary lymph node dissection following radiotherapy are at a higher risk of developing extremity lymphedema – Breast Cancer-Related Lymphedema (BCRL), a condition that results in tissue swelling and liquid retention in the arms. While it is possible to manage the condition with some home care, surgery may be necessary to significantly improve an individual’s comfort and quality of life. Ming-Heui Cheng, MD, FACS, a pioneer in plastic microsurgery and internationally renowned lymphedema specialist, performs vascularized lymph node flap transfers on lymphedema patients whose symptoms have not improved or continue to worsen six months after they emerged. Symptoms Of Lymphedema Of The Arm The affected limb may develop inflammation, infection, adipogenesis, and fibrosis of the tissue. The protein-concentrated fluid that accumulates inside the interstitial tissue may further block or make the drainage of the lymph fluid less efficient or even create an obstruction. Lymphedema of upper extremity causes pain, heaviness, skin hyperkeratosis, fibrosis, discomfort when wearing certain clothes and jewelry, cosmetic problems and limitation of daily activities for patients. It is common for lymphedema patients to experience depression, due to physical discomfort, emotional distress and lower quality of life. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Surgical Techniques 1 Lymphaticovenous Anastomosis, LVA LVA is an advanced minimally invasive super-microsurgical technique used to relieve lymphedema. During the procedure, Dr. Cheng will make small incisions, which expose lymphatic channels and small veins just beneath the skin. Learn more 2 Vascularized Lymph Node Flap Transfer, VLNT In some cases, surgery may be performed to alleviate swelling and reduce symptoms. Dr. Cheng has developed a unique technique that involves lymph node transfer. During the procedure, Dr. Cheng transfers lymph node flap to distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity. Learn more Case 61-year-old female with breast cancer-related lymphedema in the right upper limb Before Surgery: This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. After Surgery: At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. 53-year-old patient, right upper limb lymphedema clinical grade II Before Surgery: A 53-year-old patient with grade II breast cancer-related lymphedema of the right upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. 39-year-old female, left upper limb lymphedema, grade 1 Before Surgery: This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. After Surgery: At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. 49-year-old female, right upper limb lymphedema, grade 1 Before Surgery: This is a 49-year-old female with right upper limb lymphedema for 6- months after right mastectomy and axillary lymph nodes dissection and radiation. After Surgery: At a 20- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 85% and 60% above the elbow and below the elbow, respectively. Recommended reading journal Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75 https://www.ncbi.nlm.nih.gov/pubmed/19337095 Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Plast Reconstr Surg. 2013 Jun;131(6):1286-98. https://www.ncbi.nlm.nih.gov/pubmed/23714790 Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Engel H, Lin CY, Huang JJ, Cheng MH. Ann Surg. 2017 Jun 7 https://www.ncbi.nlm.nih.gov/pubmed/28594742 Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. https://www.ncbi.nlm.nih.gov/pubmed/28507857 The Submental versus Groin Vascularized Lymph Node Transfer Flaps: A Head-to-Head Comparison of Surgical Outcomes for Breast Cancer Related Lymphedema Ho OA, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 [Epub ahead of print] Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

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

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

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

Visiting Professorships Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Godina Traveling Professor, Aesthetic & Plastic Surgery Institute University of California, Irvine, Orange, California, June 10, 2006. 2006 Godina Traveling Fellow and Flap Course Faculty, Duke University. Visiting Professor, Duke University Medical Center, Durham, Nort Carolina, August 4, 2006. Visiting Lecturer, M.D. Anderson Cancer Center Department of Plastic Surgery, Houston, Texas, November 13-15, 2006. Visiting Professor in Plastic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, November 16-19, 2006. Visiting Professor in Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, November 20-22, 2006. Visiting Professor in Institute of Reconstructive Plastic Surgery, New York University Lang one Medical Center, New York, October 25-29, 2008. Visiting Professor in Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, October 29-31, 2008. Visiting Professor in Department of Plastic Surgery, The University of Texas MD Anderson Cancer, Houston, Texas, July 13-14, 2009 Visiting Professor in Division of Plastic Surgery, University of South California, Los Angeles, California, July 16-17, 2009. Visiting Professor in Division of Plastic Surgery, Mayo Clinic Phoenix, Arizona, October 27-29, 2009. Visiting Professor in Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, July 17-21,2010. Visiting Professor in Division of Plastic Surgery, Singapore General Hospital, Singapore, Singapore, July 13-17, 2011. Visiting Professor in Division of Plastic Surgery, the Ohio State University, July 10-14, 2012. Visiting Professor in Department of Plastic Surgery, MedStar Georgetown University Hospital, February 5, 2014. Visiting Professor in Department of Plastic Surgery, Brussels University Hospital, March 2-4, 2014. Visiting Professor in Department of Plastic Surgery, NYU Langone Medical Center, October 7-8, 2014. Visiting Professor in Department of Plastic Surgery, Asan Medical Center, University of Ulsan, March 26, 2015. Visiting Professor in Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, March 27, 2015. Visiting Professor in Department of Plastic Surgery, University of Michigan, September 22-25, 2015. Visiting Professor in Department of Plastic Surgery, the Keck School of Medicine of the University of Southern California, January 14 - 15. 2016 Visiting Professor in Department of Plastic Surgery, Duke University Medical Center, Durham, North Carolina, February 22, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, University of California, San Diego, May 16-17, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, The University of Chicago Medicine & Biological Sciences,Chicago, September 18-19, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, University of California, Irvine, November 7-8, 2016. Visiting Professor in Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, August 21, 2017. Visiting Professor in Department of Plastic Surgery, University of Michigan, Detroit, August 28 to 30, 2017. Visiting Professor in Department of Plastic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, November 3 to 4,2017. International Visiting Professor in Plastics Division, Stanford University, February 16-21, 2018. Visiting Professor in Department of Plastic Surgery, University of Michigan, Detroit, July 29 to August 1, 2018. Visiting Professor in the Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, August 8 to 10, 2019. Buncke Clinic Virtual Visiting Professor, Webinar, May 9, 2020. Visiting Professor in the Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, May 2 to 6, 2022.

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.

補助基金專區 幫助姐妹們找回自信與美麗！ 社團法人台灣乳房重建協會 2022乳房重建醫療補助辦法勸募活動 一、本辦法依據台灣乳房重建協會「乳房重建補助基金」審核委員會決議訂定之。 二、申請資格： 乳房因乳癌切除者。 先天性乳房發育不全者。 重建手術時間為109年7月1日至111年6月30日。 申請補助有通過者，需具備台灣乳房重建協會會員資格，方能領取補助款 三、申請時間：即日起至111年11月10日止 四、補助方式： 五、補助要件： 限在本國各醫(醫學中心、區域醫院及地區醫院)接受手術者。 檢附文件： 2-1 乳房重建醫療補助申請書 2-2 身分證正反面影本 2-3 診斷證明書（證明為乳癌或先天性乳房缺損患者） 2-4 重建手術紀錄單影本（詳載乳房重建方式） 2-5 重建手術住院就醫收據影本 2-6 如有政府機關核定之中低收入戶或身心障礙手冊可檢附。 六、文件郵寄： 桃園市333龜山區復興街5號醫學大樓5B乳房重建中心諮詢室 台灣乳房重建協會 林怡伶小姐收 七、作業時程： 收件：即日起-11/10寄出申請書後，可電詢本會是否已收件。 專業審查及審核委員會審核：111/11/10-12/10由專業醫師審查是否符合資格。由審核委員會審核個案基本資料。 核定通過通知：111/12/10-12/30寄發核定通過通知書，通過核發者備妥所需資料寄回本會，俾利後續撥款作業。 八、申請乳房重建補助通過者，須繳交300-500字心得(罹癌心情，得到重建補助心情感想等)，隨即發放補助款。 九、本辦法經本會審核委員會通過，報經本會理事會核備後實施，修正時亦同，本會保有修改之權利。 十、相關訊息及公告，刊登於本會網站 http://www.nicebreast.com.tw 十一、相關問題請洽詢本會秘書處：0933036472，電子郵件：ebreast@gmail.com 十二、備註： 資源有限，當申請人數超過可補助名額，以身心障礙、年輕型乳癌患者35歲以下、單親或低收入者優先補助。 所有申請文件不論通過補助與否，一律不予退件。 審核通過者，本會將以專函通知。 108年9月15日審核委員會修訂 108年9月15日理監事會通過 回到乳房重建中心

乳頭整型 客製化完美比例，找回自己最舒服的美 乳頭凹陷 先天性乳頭凹陷，導因於乳頭下的纖維結締組織增生，將乳頭往下牽引所造成。在門診常見求診的原因多數是美觀的考量及擔心因乳頭凹陷而影響哺餵母乳時造成嬰兒吸允上的困難。 乳頭凹陷可分為三個等級，第一級乳頭凹陷是最輕微的，乳頭有時是凹陷，有時可自然突出，第二級乳頭凹陷可藉由擠壓而鼓出，第三級乳頭凹陷則因乳頭下纖維結締組織增生較嚴重，無論如何擠壓都無法將之推出，除了外觀不好看，凹陷的乳頭較易藏汙納垢，造成清潔上的困難。 乳頭凹陷手術，在乳頭乳暈的交界處施行一個約零點五公分的切口，利用手術用鈍剪刀將纖維組織放鬆，保留乳管，之後於乳頭周圍以特殊的方式包埋一層縫線，以固定乳頭型狀。局部麻醉，手術時間約1小時。 術後乳頭的感覺，並不會受到手術的影響，手術後預後良好，再復發乳頭凹陷積率極低。 手術成果 乳頭凹陷 (1) 乳頭凹陷 (2) 乳頭凹陷 (3) 乳頭縮小 有些婦女在懷孕、生產或哺乳以後乳頭變大變長變寬，後來乳頭組織增生，所以乳頭無法回覆到以前的樣子，通常亞洲女性乳頭會超過一公分寬度及高度甚至到達兩公分，有時在美觀上不是那麼好看，需要做乳頭縮小手術，乳頭縮小手術有需多技術被發表過，但有些手術後會影響乳頭中間的神經及血管甚至外觀結果不佳，我們使用的技術是「改良式頂帽手術縮小」，首先設計乳頭需要的寬度、直徑及高度，把它先畫出來，將不要的組織部分除掉，這會像一個偏心的圓，將弦月亮部分切掉，還有高度也修掉，中間乳頭的血管及神經是保留的，必要時可以減掉一些乳腺或乳管組織，但大部分乳管、神經及血管是保留的。 可以依照希望的高度調整，一般若女性是C罩杯會希望乳頭高度大約0.8公分，乳暈也差不多0.8公分。切除後將兩邊乳頭側邊高度的皮瓣掀開，將多的皮膚修掉，這樣高度及寬度直徑都減少，用5-0 Nylon縫合，達到乳頭縮小的效果，與乳房達到較完美的比例，也符合病人所期望的美觀。 資料來源：Cheng MH， Smartt JM， Rodriguez ED， Ulusal BG. Nipple reduction using modified top hat flap. Plast Reconstr Surg. December 2006; 118（7）:1517-25.鄭明輝醫師所發表 手術成果 乳頭縮小 (1) 乳頭縮小 (2) 乳頭縮小 (3) 回到乳房重建中心