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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 聯繫我們 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！ 營業時間：週一至週五 AM08:00 至 PM 18:00，六日公休 Address 台北市松山區復興北路337號3樓 (捷運中山國中站) 點此看路線 Phone (+886) 02-2712-3373 撥打電話 (+886) 0966-523-737 撥打電話 Email aplussurgery@gmail.com Social Media 專人服務(報名/諮詢) 您的姓名 性別 * 男 女 其他 Email 居住地 * 台灣 海外 電話 方便聯絡時段 選擇一個時段 其他 Send 預約成功！

WELCOME Dear Esteemed Guests, Distinguished Colleagues, and Honored Speakers, It is with great pleasure and excitement that we extend a warm welcome to all of you to the 10 th World Symposium for Lymphedema Surgery, held at the prestigious Taipei Garden Hotel, Taipei, Taiwan from April 22 to April 24, 2024. This symposium represents a significant gathering of surgical professionals, researchers, and experts from around the world, all dedicated to advancing the field of lymphedema surgery. Over the next three days, we have meticulously curated a program that offers a platform for the exchange of knowledge, the exploration of cutting-edge research, and the sharing of invaluable experiences. One unique and groundbreaking feature of our symposium is the inclusion of the "Live Surgery Demonstrations" section. This pioneering component will allow attendees to witness, in real-time, surgical procedures related to lymphedema surgery, providing an extraordinary opportunity to observe the latest techniques and advancements firsthand. We believe this hands-on experience will greatly enhance the educational value of our symposium. Our distinguished speakers, who are leaders in the field of lymphedema surgery, will present their insights, innovations, and breakthroughs that promise to shape the future of patient care. We are honored to have such a wealth of expertise under one roof. Furthermore, we believe that the spirit of collaboration and networking is fundamental to progress in medicine. Therefore, we have designed this symposium to facilitate discussions, foster new collaborations, and nurture lasting professional relationships. We express our heartfelt gratitude to all those who have contributed to the realization of this symposium—our speakers, sponsors, partners, and, of course, each and every attendee. Your presence here makes this event truly special. As we embark on this enlightening journey together, we encourage you to engage actively, exchange ideas passionately, and, above all, take inspiration from the collective dedication to advancing the understanding and treatment of lymphedema. Once again, welcome to the World Symposium for Lymphedema Surgery. We anticipate an inspiring and productive symposium and look forward to the groundbreaking discoveries and friendships that will undoubtedly emerge. With warm regards, Co-Chairmen 10 th World Symposium for Lymphedema Surgery Ming-Huei Cheng, MD, David Chang, MD, and Jaume Masia, MD. Chairpersons Ming-Huei Cheng, MD David W.Chang, MD Jaume Masia, MD

延遲性乳房重建是指乳癌患者在做乳房切除手術的時候，沒有選擇同時做乳房重建，或者因資訊的不足而失去選擇立即性重建的機會，有些病人是當時因為恐懼癌症的心理、擔心手術的成功率等等而暫時不接受重建手術，在乳癌治療包含完成化學治療或/及放射線治療一段時間後才進行乳房重建，此二次手術做法稱之為延遲性乳房重建。 Partial Mastectomy with Breast Reconstruction 部分切除後再乳房重建 治療說明 隨著乳頭保留乳房全切除手術的發展，通過最高安全風險控管，切除乳房時保留乳頭、乳暈、皮膚，立即重建的外觀最自然，感覺性最佳。 乳房保留手術的原意，本在於不違背癌症治療的原則與安全性之下，保留健康的乳房組織與乳頭，讓病患術後對於失去乳房的衝擊減到最少，輔以化療及放射線治療，以減少復發的可能性。 近年來，在乳房重建普遍受到認同後，乳頭及皮膚保留式全乳切除併立即性乳房重建也漸漸受到病患的青睞，若是病情符合手術適應症，乳房外科醫師會在整形重建醫師的合作下，提供病患這樣的選擇。 安德森， 您的安心選擇 醫學中心規格設備 手術室配備全台僅四台的Mitaka顯微鏡， 具有高達1600萬像素、可光學放大42倍的功能，非常適合在0.5mm的淋巴管及靜脈接合，常用在淋巴管靜脈吻合術，如：術前評估、術中評估縫合的通透性， 使手術更穩定、安全。 什麼情況適合乳頭保留式全乳切除手術? 在過去有限的乳癌治療方式之下，乳頭保留式全乳切除手術，僅限於腫瘤小而且距離乳頭遠的患者，而現在，在手術中有乳頭放射線治療的幫助下，腫瘤距離乳頭2公分以內的患者，如果手術前在乳房外科醫師的超音波檢查評估後，認為適合接受乳頭保留手術，可以在手術中以乳頭放射線治療來輔助控管保留的安全性。 當然，手術中還有最後的把關，也就是術中乳頭內組織的冷凍切片檢查，確定乳頭沒有受到惡性腫瘤的侵襲，才能保留乳頭；而腫瘤較接近乳頭的病患，則必須加做手術中的乳頭放射線治療，這樣才能萬無一失。 保留乳頭會容易復發嗎? 手術前的把關是很嚴謹的，但仍然有患者感到不安，原因不外乎擔心乳頭處的腫瘤復發，以及保留乳頭所帶來的併發症。 乳頭保留手術其實已經行之有年，在條件許可下，術後的腫瘤復發機率是很低的，與一般全乳切除手術相比，並無差異。 乳頭保留有合併症嗎? 另一個令人擔心的問題是，保留的乳頭血液循環是否完好？會不會壞死？這個部分當然有賴醫師的技術，技術純熟的醫師都可以做得很好的，當然，仍可能會有合併症的產生，例如：乳頭血液循環不好，局部壞死或大部分壞死而需移除乳頭。 此外，手術中我們也有特殊的監控照相儀器做檢查，以增加手術的安全性，如果有疑慮，則將一階段重建改為二階段重建，就可以兼顧重建目的與手術安全。 Contact us 鄭教授是美國重建顯微外科學會的會員，以顯微外科技術聞名國際。如果您想進一步了解淋巴靜脈解剖學和顯微淋巴水腫治療方法，請聯繫鄭教授。根據您的具體情況，鄭教授將推薦最佳治療方法，以減少腫脹並改善生活質量。 如果您患有乳癌相關淋巴水腫（BCRL）並希望了解更多有關最先進的治療方式，歡迎線上諮詢。 線上諮詢

FACULTY Chairpersons Ming-Huei Cheng, MD A+ Surgery Clinic – Taiwan David W. Chang, MD The University of Chicago Medicine – USA Jaume Masià, MD Hospital de la Santa Creu i Sant Pau – Spain Stephen F. Sener Los Angeles General Medical Center – USA Isao Koshima The Hiroshima University Hospital – Japan Peter C. Neligan The Royal Infirmary of Edinburgh – England William Repicci President & CEO of the Lymphatic Education and Research Network (LE&RN) – USA Håkan Brorson Lund University Cancer Centre – Sweden Corrado C. Campisi CEO and Head Surgeon of Campisi Clinic, Italy Hung-Chi Chen China Medical University Hospital – Taiwan Wei F. Chen University of Iowa Hospital – USA Dimitris Dionysiou Medical School Aristotle University of Thessaloniki – Greece Akitatsu Hayashi Kameda Kyobashi Clinic Kameda Medical Center – Japan Nicole Lindenblatt University Hospital Zürich – Switzerland Gurusamy Manokaran Apollo Hospital Chennai – India Dung H. Nguyen Stanford University – USA Alexandru Nistor University Hospital UZ Brussel - Belgium Marco Pappalardo University of Modena and Reggio Emilia – Italy Ketan M. Patel Sinai Tarzana Medical Center – USA Gemma Pons Hospital de la Sant Creu i Sant Pau – Spain Christy Russell LAC + USC Medical Center – USA Yukio Seki Cancer Institute Hospital of JFCR – Japan Dhruv Singhal Harvard Medical School – USA Sinikka Suominen Helsinki University Hospital, Park Hospital Giuseppe Visconti Fondazione Policlinico Universitario Gemelli IRCCS – Italy Takumi Yamamoto National Center for Global Health and Medicine – Japan Johnson, Yang Kaohsiung Chang Gung Memorial Hospital, – Taiwan

Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. International Fellows Dr. Cheng have trained 87 international fellows and 714 short-term international visiting scholars since 2000. Some of them are actively practicing Lymphedema Microsurgery in their own countries. MD Joseph H Dayan Fellowship: 2008-2009, Present position: Associate Professor at Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center MD, PhD, FACS Holger Engel Fellowship: 2008-2009, Present position: Professor at Division of Plastic Surgery, BG Trauma Center Ludwigshafen, Germany MD, PharmD Dung Nguyen Fellowship: 2010-2011, Present position: Associate Professor at Division of Plastic Surgery, Stanford University Medical Center MD Wei Fen Chen Fellowship: 2010-2011, Present position: Professor at Division of Plastic Surgery, Cleveland Clinic MD Dhruv Singhal Fellowship: 2011-2012, Present position: Assistant Professor at Division of Plastic Surgery, Beth Israel Deaconess Medical Center/ Harvard Medical School MD, MBA John Chieh-Han Tzou Fellowship: 2012-2013, Present position: Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Ketan M. Patel Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, University of Southern California MD Shan Shan Qiu Fellowship: 2013-2014, Present position: Assistant Professor at Division of Plastic Surgery, Maastricht University Medical Center, the Netherlands MD, FRCSC Hattan Aljaaly Fellowship: 2014-2015, Present position: Assistant Professor at Division of Plastic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia MD, MS, FRCSC Olivia Ho Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, Mayo Clinic MD, MSc Marco Pappalardo Fellowship: 2016-2017, Present position: Assistant Professor at Division of Plastic Surgery, University of Palermo, Italy MD, FRCSC Arash Izadpanah Fellowship: 2017-2018, Present position: Assistant Professor at Division of Plastic Surgery, University of Manitoba MD Ines Tinhofer Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, Medical University of Vienna, Austria MD Satomi Koide Fellowship: 2018-2019, Present position: Assistant Professor at Division of Plastic Surgery, St. Vincent Hospital, Australia MD Chrisovalantis Lakhian Fellowship: 2019-2020, Present position: Assistant Professor at Division of Plastic Surgery, Georgetown University Medical Center MD Onur Aksoy Fellowship: 2023-2024, Present position: Prof Dr Cemil Tascioglu City Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey

了解更多有關術後照顧的重點，患者不再需要穿戴壓力袖套、襪，但建議患者在術後接受3~6個月的復健，需要積極治療。 Post-Operative Care 術後照顧要點 術後復健 安德森整形外科淋巴水腫顯微中心會在手術前、後提供全面完善的醫療服務。接受鄭教授的邊對端淋巴管靜脈吻合術或顯微淋巴結皮瓣移植術後(論文已發表)，患者不再需要穿戴壓力袖套/襪，但建議患者在術後接受3～6個月的復健，術後1個月每天3次從近心端至遠端部位按摩15分鐘，持續3～6個月，以進一步改善淋巴引流。 手術後追蹤 上下肢的淋巴水腫都會引起患者的疼痛、不適、纖維化、活動受限及美觀問題。淋巴水腫患者因身體不適、肢體變形，經常和情緒困擾而出現不同程度的憂鬱是很常見的問題，一定要積極治療。 根據我們的調查統計，在接受邊對端淋巴靜脈吻合術或顯微淋巴結皮瓣移植術2年後，患肢會隨著時間的增加變得更加柔軟，90％的淋巴水腫患者的肢體大小有所改善，平均肢體周長改善為40~50％，同時隨著身體的改善，患者對於能恢復日常活動和生活方式都感到滿意。顯微淋巴結皮瓣移植術後，我們建議您遵守我們制定的復健計劃，包括逐步進行下肢肌肉力量訓練、下肢近端（腹股溝）向遠端（踝部）淋巴引流，或上肢近端（腋下）向遠端（手腕）淋巴引流，同時應按摩皮瓣疤痕，並在出院後開始控制體重。近端（腹股溝）向遠端（踝部）淋巴引流和皮瓣按摩，每次15分鐘/次，每天3次。根據“抽水馬達”機制和重力作用，我們將顯微下頜淋巴結皮瓣移植到手腕或腳踝上，手術後逐漸恢復正常活動，並停止穿戴壓力袖套或壓力襪，在傷口完全癒合後，您可以戴上腕帶以隱藏手腕上的疤痕。建議在顯微下頜淋巴結皮瓣移植1年後進行另一次修復手術，去除皮瓣的皮膚及其淺層脂肪來改善外觀，同時透過近端大腿或上臂抽脂減少脂肪體積，以減少淋巴液的產生。 1. 反向徒手淋巴引流（與手術前方向不同） 時間：下肢部分從腹股溝引流到皮瓣，上肢部分從上臂引流到手腕，每天進行3次，每次15分鐘。 方法：中等強度的按摩，下肢部分從近端（腹股溝）向遠端（皮瓣）方向。上肢部分從上臂引流到手腕方向，按壓皮膚、皮下、脂肪和肌肉，有助於促進淋巴結皮瓣功能及引流量。 2. 皮瓣按摩（用於增加顯微淋巴結皮瓣抽吸的靜脈引流） 時間：建議用手動血壓計，以90~120mmHg 加壓，進行3~5分鐘/次，每天6次。 方法：中等強度按摩淋巴結皮瓣和皮瓣周圍的疤痕。 3. 體重控制 時間：每天檢查體重。如果您的體重指數（BMI）超過25，建議減輕體重。 4. 感染/蜂窩組織炎的預防和控制 維持良好的衛生習慣可以預防大多數醫療保健相關的感染，重要的是要及早發現和治療蜂窩性組織炎，一旦發炎，會影響到您的整個身體。發炎可能的症狀表現如下： 肢體腫脹 皮膚變成紅色或“產生新的紅色斑點”，傾向於從遠端延伸到近端 腫脹部位壓痛 腫脹部位疼痛 發燒超過38.5℃ 術後初期可以透過微信Wechat、Line、WhatsApp、Skype或電子郵件，發送傷口圖片給林佳佑博士來確認傷口狀況。透過您的主觀改善、臂圍測量、蜂窩組織炎的發生頻率，以及通過患者的健康相關生活質量結果指標，來客觀評估手術結果。若接受皮瓣移植手術，可以在一年後將皮瓣的皮膚修掉縫成一條線增加外觀美化，並在上臂或大腿抽脂，以減少脂肪數目與淋巴產生，改善外觀。

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 聯繫我們 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！ 營業時間：週一至週五 AM08:00 至 PM 18:00，六日公休 Address 台北市松山區復興北路337號3樓 (捷運中山國中站) 點此看路線 Phone (+886) 02-2712-3373 撥打電話 (+886) 0966-523-737 撥打電話 Email aplussurgery@gmail.com Social Media 專人服務(報名/諮詢) 您的姓名 性別 * 男 女 其他 Email 居住地 * 台灣 海外 電話 方便聯絡時段 選擇一個時段 其他 Send 預約成功！

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 成果照片分享： 治療輕度至中度淋巴水腫 淋巴管靜脈吻合術 (Lymphovenous Anastomosis, LVA) 手部 案例一 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. 案例二 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. 案例三 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. 案例四 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. 案例五 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. 淋巴管靜脈吻合術 (Lymphovenous Anastomosis, LVA) 腳部 案例一 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. 案例二 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. 案例三 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. 案例四 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.

瞭解更多顯微淋巴結皮瓣移植的適合對象、手術結果、術前及術後的對比和分析，全部來自於鄭明輝教授的多年經驗。 Gallery 成果照片分享： 治療中度至重度淋巴水腫 顯微淋巴結皮瓣移植 (Vascularized Lymph Node Transfer, VLNT) 手部 案例一 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs 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. At 2- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 27% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 36% and 15% above and below the elbow, respectively. The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 and 27 months. At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 60% and 10% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 72- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 50% above and below the elbow, respectively. 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. 案例二 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 38% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 6- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 32% and 15% above and below the elbow, respectively. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 30% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 18- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 90% and 40% above and below the elbow, respectively. At 22- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 35% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs 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. 案例三 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 21- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 70% and 30% above and below the elbow, respectively. At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively. 案例四 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 6-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 20% above the elbow and 15% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 24-months follow-up, the reduction rate was 60% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 33-months follow-up, the reduction rate was 50% above the elbow and 25% below the elbow without the use of a compression garment. 案例五 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 12 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. At the 3-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 22% above the elbow and 25% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 6-months follow-up, the reduction rate was 35% above the elbow and 25% below the elbow without the use of a compression garment. At the 12-months follow-up, the reduction rate was 30% above the elbow and 20% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in the wrist and liposuction for the left upper medial arm 14 months after surgery. At the 24-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow without the use of a compression garment. At the 38-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow. The patient was satisfied with the functional and cosmetic outcomes and did not wear a compression garment. 案例六 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 51-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 6 months after mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment. At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment. The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment. At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment. 案例七 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 18 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was received non-vascularized lymph node transfer by other doctor on left elbow, and refractory to conservative decongestive therapy. At the 3-months follow-up, the reduction rate was 10% above the elbow and 23% below the elbow without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At the 10-months follow-up, the reduction rate was 20% above the elbow and 30% below the elbow without the use of a compression garment. The skin paddle in the middle forearm was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At the 20-months follow-up, the reduction rate was 100% above the elbow and 42% below the elbow without the use of a compression garment. 案例八 Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs This is a 46-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 2 years after mastectomy, axillary lymph node dissection, and radiotherapy. She developed one episode of cellulitis per year with the use of compression garments. At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 20% and 15% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 24- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 37% and 20% above and below the elbow, respectively. At 38- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 25% above and below the elbow, respectively. Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs At 70- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 75% and 50% above and below the elbow, respectively. 顯微淋巴結皮瓣移植 (Vascularized Lymph Node Transfer, VLNT) 腳部 案例一 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 65-year-old female with grade IV left lower limb lymphedema for 3 years after cervical cancer and radiation. At the 3 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 30% above the knee and 40% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 9 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 85% below the knee without the use of a compression garment. 案例二 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs A 67-year-old female with grade IV right lower limb lymphedema for 8 years after cervical cancer and radiation. She was refractory to conservative decongestive therapy. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 15% above the knee and 5% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 67 months of follow-up, after flap revision and right lower limb liposuction. The circumferential reduction rate was 62% above the knee and 50% below the knee without the use of a compression garment. 案例三 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 15-year-old patient with left lower limb congenital lymphedema for 2 years. At the 24 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment. 案例四 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 5-year-old patient with right lower limb congenital lymphedema for 2 years. At the 15 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 20% above the knee and 15% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 13 months of follow-up, after flap revision. The circumferential reduction rate was 25% above the knee and 20% below the knee without the use of a compression garment. 案例五 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 40-year-old patient with left lower limb congenital lymphedema for 15 years. At the 6 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 5% above the knee and 23% below the knee without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 36 months of follow-up, after flap revision and left lower limb liposuction. The circumferential reduction rate was 55% above the knee and 56% below the knee without the use of a compression garment. 案例六 Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs This is a 52-year-old female with grade II left lower limb lymphedema and grade I right lower limb lymphedema for 5 years after cervical cancer and radiation. At the 1 month of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment. Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs At the 19 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment.

延遲性乳房重建是指乳癌患者在做乳房切除手術的時候，沒有選擇同時做乳房重建，或者因資訊的不足而失去選擇立即性重建的機會，有些病人是當時因為恐懼癌症的心理、擔心手術的成功率等等而暫時不接受重建手術，在乳癌治療包含完成化學治療或/及放射線治療一段時間後才進行乳房重建，此二次手術做法稱之為延遲性乳房重建。 Delayed Reconstruction 延遲性重建 治療說明 延遲性乳房重建是指乳癌患者在做乳房切除手術的時候，沒有選擇同時做乳房重建，或者因資訊的不足而失去選擇立即性重建的機會，有些病人是當時因為恐懼癌症的心理、擔心手術的成功率等等而暫時不接受重建手術，在乳癌治療包含完成化學治療或/及放射線治療一段時間後才進行乳房重建，此二次手術做法稱之為延遲性乳房重建。 再造雙峰奇蹟，找回美麗自信 右乳
DIEP Flap 右乳
DIEP Flap+左乳義乳 安德森， 您的安心選擇 醫學中心規格設備 手術室配備全台僅四台的Mitaka顯微鏡， 具有高達1600萬像素、可光學放大42倍的功能，非常適合在0.5mm的淋巴管及靜脈接合，常用在淋巴管靜脈吻合術，如：術前評估、術中評估縫合的通透性， 使手術更穩定、安全。 延遲性重建是否比較困難? 延遲性乳房重建相較於立即性的乳房重建稍微來得困難一點，皮膚的不足、手術後的疤痕組織，以及淋巴結廓清後的腋下凹陷，都是需要額外考量的部分。 第一，在接受全乳切除時，因為已決定不接受立即性重建，乳房外科醫師會把多餘的皮膚切掉，再將傷口直接縫合成一條直線。所以進行自體組織乳房重建時，除了來自肚子、背部或者臀部、大腿等地方的脂肪，覆蓋其上的皮膚也很重要，若是患者決定接受義乳重建，或者希望重建術後的疤痕像立即性重建一樣侷限於一小部位，就需要多一道步驟，先植入組織擴張器將皮膚撐鬆。 第二個困難是在於整個胸部的組織會有疤痕組織沾黏，或者纖維化。在重建手術時，醫師會盡量把這些疤痕都放鬆，才能做出一個漂亮的乳房。 第三個問題是腋下的淋巴結大部分都已被切除掉，腋下凹陷明顯易見，在重建的時候若能將凹陷一併補滿，會是最令人滿意的結果，尤其對夏天的穿著會有明顯的改善，衣著的選擇也較不受限。 另有一個專業上的困難，若是選擇自由皮瓣乳房重建，醫師需要在胸部找到一套健康的血管，以做為皮瓣血液的供應。而在延遲性重建的時候，有時胸背動脈會因第一次手術時的傷害而無法使用，或是因為疤痕組織嚴重，剝離困難。當然，這個問題對於經驗豐富的醫師而言不是最困難的，專業而與實時俱進的醫師，已經大多都採用內乳動靜脈來做為吻合的血管。內乳動靜脈的手術方法比胸背動脈的方法來得困難，沒有經驗的醫師多不敢貿然使用，但使用內乳動靜脈的結果，會比使用胸背動脈來得漂亮，而且因為血液供應充沛，皮瓣的脂肪存活極佳。 延遲性重建雖然有其困難，但這些困難在有經驗的醫師手中都可以克服。所以，延遲性的乳房重建仍可達到自然、漂亮的結果，仍是很值得推廣的一個重建手術。乳癌的治癒率已經很好，我們衷心認為，病患不應因為失去乳房而須一再忍受不便，或者終生感到缺陷與遺憾。 什麼時候可以做延遲性重建? 目前來自世界上最佳的癌症醫院研究結果，一致認為乳房重建可以在乳房切除的同時做重建，並不會增加乳癌的復發率，更不會去干擾萬一有乳癌復發時的偵測，因此，這已不只是趨勢而已，是每一位乳癌患者一經診斷，就會被立即會診整形科醫師討論重建的原因。所以，只要病人有意願做乳房重建的時候，就是適合乳房重建的好時機。 在過去有一段時間，醫師鼓勵病患在乳房切除後兩年內不要做重建，原因是乳癌復發最多是發生在兩年內，然而，近年來，已不再做這樣的限制與建議，乳癌的復發率在台灣，尤其在長庚醫院病例中是4-5%，在美國是 2-3%。權衡這4-5%的復發率以及其他95%的病人的生活品質與心理建設，這樣的建議顯得不合理也不公平。讓病患早日自覺真正脫離了乳癌，是重建醫師最大的任務與成就感。 現在較普遍的共識是：在做完乳房切除後，如果還要做化學治療或放射線治療，待這2項治療都完成，一般化學治療後建議等1個月左右，放射線治療建議等3至6個月後，就可以進行乳房重建手術。 延遲性乳房重建，可以用哪些方法來進行呢? 第一個我們要提到的是用義乳，也就是生理食鹽水袋或果凍矽膠。前面提及在延遲性乳房重建的時候，胸部的皮膚是不足的，所以若是使用義乳來做重建，會需要經過組織擴張器的過渡時期。組織擴張器顧名思義是用來擴張皮膚或組織，需要一次手術將它植入皮下，通常須將皮膚撐得比對側乳房略大，再3個月後，皮膚狀況穩定時，再一次手術把組織擴張器取出，植入永久性的義乳。 第二種是使用局部自體組織來做重建，或使用自由式游離皮瓣來進行乳房重建手術。 放射線治療後，較適宜的乳房重建方式 若病患曾接受放射線治療，並不建議單純以組織擴張器及義乳的方式做重建，因為放射線治療會使胸部的皮膚纖維化，不但容易產生莢膜孿縮，導致外觀不佳，經歷放射線治療的皮膚，也容易產生傷口癒合不良及義乳外露的問題。 若因為自體組織的不足而須選擇以義乳做重建，建議病患應選擇闊背肌皮瓣輔以義乳做重建，才能達到美觀也兼具安全的結果。 乳房未重建前的過渡期：義乳胸衣該如何購買與挑選？ 經過乳房切除手術，特別是延遲性乳房重建的患者，都會歷經一段無法如常穿著內衣的日子，為了考慮生理平衡與穿著衣服時的外觀，很可能需要穿著特製的義乳胸衣。義乳胸衣畢竟是「身外之物」，即使目前技術製作精良，仍有沉重而無法緊密貼合身體的缺點，單側重量不易平衡，所以並非長久之計，建議患者及早與醫師討論乳房重建的時間，解決根本的問題。 義乳胸衣的選購管道並不普及，有專業廠商特別生產製作，有些能提供量身訂製義乳襯墊與汰換加購等後續服務。患者可向乳房外科或整形重建外科醫師、護理師請教相關專業資訊與挑選的建議。 款式挑選注意事項： 義乳胸衣款式，避免摩擦手術傷口(例如有做腋下淋巴結廓清術，胸衣腋下部位開口宜稍低) 襯墊內袋要夠深，避免動作大時襯墊滑動鬆脫 寬肩帶及下圍支撐設計，可減輕肩膀承重負擔 胸前宜有加高包覆，避免襯墊滑脫外露 背面式開扣，避免經常摩擦與壓迫傷疤，造成疼痛、組織增生 布料伸縮性要良好，能服貼身體曲線為佳 Contact us 鄭教授是美國重建顯微外科學會的會員，以顯微外科技術聞名國際。如果您想進一步了解淋巴靜脈解剖學和顯微淋巴水腫治療方法，請聯繫鄭教授。根據您的具體情況，鄭教授將推薦最佳治療方法，以減少腫脹並改善生活質量。 如果您患有乳癌相關淋巴水腫（BCRL）並希望了解更多有關最先進的治療方式，歡迎線上諮詢。 線上諮詢