Search For:

Travel Visa What is a visa? A visa is a permission certificate or a stamp on a non-citizen applicant’s passport to enter a particular country. To apply for a visa to Taiwan, please visit a Taiwan Representative Office nearest to you. Types of Visas to Taiwan: Visitor, Business Visa: (effective for 7 to 30 days) A U.S citizen doesn't need a visa to visit Taiwan for up to 30 days. Please apply for your visa before your arrival in Taiwan, if you are not a U.S. citizen. For most patients, a visitor visa should offer sufficient time to undergo most kinds of medical checkups, examinations, and treatments. In the event that you are required to stay for longer than one month, we will assist you in applying for a medical visa. A formal certificate of diagnosis will be provided to you for the request of time extension for a medical visa. Landing Visa / Visa Exemption Please complete the immigration card WHILE on board the incoming flight. Citizens of some countries are eligible for a landing visa or visa exemption, which permits individuals to enter Taiwan without prior visa application for a duration of 30 to 90 days. Please click on the link on landing visa for more information. Please click on the link on visa exemption for more information. Entry Permit for Certain Passport Holders For citizens of certain countries, such as Pakistan, Iraq, Myanmar (Burma), Ethiopia, Nigeria, and Afghanistan, a formal medical visa letter signed by our hospital’s doctor will be required to gain entry into Taiwan. Travel Information Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Once you have confirmed and accepted your treatment plan, we will contact you to double-check and confirm the dates of your previous appointments. We will prepare the necessary travel visa, airport pick-up and hotel accommodation for you, and also make it easy for you to contact us. Travel Destination Known as the “heart of Asia”, Taiwan is packed with exciting things to do, beautiful sights to see, amazing food to try, festivals to enjoy, and friendly people to meet. Taiwan is famous for its landscape, rich heritage, diverse folk traditions, mild climate, magnificent temples, and numerous national museums. It has become a very popular travel destination in Asia because of its convenient and efficient transportation system, safe and secured environment, kind people, and affordable cost of travel. Taiwan’s unique tourism attractions – the combination of traditional Asia and the modern world, the contrast between metropolitan and countryside, the blending cultures of the old and the new, stunning scenery of mountains, coastlines and valleys, and tasty local food and international cuisines – bring tourists back to this beautiful island year after year. Taipei 101 Located in the finest district Taipei has to offer, TAIPEI 101 is the largest engineering project ever in the history of the Taiwan construction business. At 382 meters above the ground the 89F Observation Floor offers visitors a commanding view of the city and Taipei Basin at all directions. Yehliu Geopark Yehliu Geopark is truly a park of natural wonders: rocks carved by wave-cutting and weathering over years and years were formed into shapes resembling figures that are real. The most famous one is of course the Queen’s Head, among other “statues” that are named the Fairy’s Shoe, the Mushroom Rocks, the Tofu Rocks, and the Elephant Rocks, along with many interesting potholes. Do not forget to bring your camera. Sun Moon Lake The Sun Moon Lake National Scenic Area is praised for its five major recreational systems, including the lake, Shueili River, Puli, Jhuoshuei River, and Jiji. The surrounding areas stretch to cover known tourist spots including Taumi, Checheng, Jiji, Shueisheda Mountain, Sangyong Falls, Mingtan Reservoir, and Shueili River. Sun Moon Lake features the only full-range 3D tours (lake, sky and land) in Taiwan. The lake cycling trail has been recognized by CNNGO, CNN as one of the most beautiful cycling trails in the world. *Travel Visa Information : National Immigration Agency www.taiwan.net.tw Taroko National Park Taroko is famous for its spectacular mountains and marble canyons. Cliffs and canyons stretch along Liwu River. The waterfalls characterized Taroko National Park and the most famous ones are Baiyang Waterfall, Yindai Waterfall, Changchun Waterfall, and Lushui Waterfall. Swallow Grotto (Yanzikou) and Tunnel of Nine Turns (Jiuqudong) are the most impressive natural scenes in Taroko and the canyons here are the narrowest.

Dr. Cheng, a world authority in micro-reconstructive plastic surgery and lymphedema treatment, provides surgical services such as lymphedema treatment, breast reconstruction, breast augmentation, double eyelids, eye bags, liposuction, wrinkle removal and lift. Contact A+ Surgery Clinic for more information. 25 Years of Surgical Experience An Authority in Lymphedema, Breast Reconstruction, and Aesthetic Medicine - lymphedema - microsurgery - Taiwan - breast reconstruction - A+ Surgery Clinic Dr. Cheng is Affiliated With 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 Coming to Anderson feels as comforting as home. Patient Testimonials Patient Testimonials Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search video... Now Playing Lymphedema Treatment Testimony: Canadian Patient at A+ Surgery Clinic, Taipei, Taiwan"Video Content: 09:51 Play Video Now Playing Lymphedema Treatment Testimony:In addition to excellent medical care, also enjoys Taiwanese cuisine 04:27 Play Video Now Playing Mr. William from Australia 05:50 Play Video A+ Surgery Clinic offers treatment for: Primary lymphedema Upper limb lymphedema following breast cancer treatment Lower limb lymphedema following gynecological cancer treatment Lower lymphedema presented after trauma or other surgeries lymphedema, microsurgery, Taiwan, breast reconstruction, A+ Surgery Clinic Outpatient clinic hours Tuesday, Thursday and Friday. 1:30 - 4:00 p.m.

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 ！

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

Am I A Candidate? 我適合什麼手術？淋巴水腫手術的適合對象、不同治療方案和術後注意事項 Am I A Candidate? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Suggested Candidates For Lymphedema Surgery A full medical history and thorough physical exam are required for the initial clinic visit. The circumferential differentiation between the affected and unaffected limbs (in unilateral disease) will be the focus, and measured comprehensively during the physical exam. Who is eligible for lymphedema surgery? A complete history, complete examination and diagnosis of both the lymphedematous limb and the unaffected limb (unilateral disease) are required at the initial visit. Based on the research results, Dr. Cheng's lymphedema grading system can establish a diagnosis and formulate treatment plans for patients. 1 Suggested candidates for Lymphedema surgery are as follows: Lymphedema patients who aggressively receive rehabilitation for more than 6 months without significant improvement. Lymphatic obstruction present in lymphoscintigraphy. The difference of circumference between the affected and non-affected limbs is more than 10%. Cancer patients with the aforementioned indications without tumor recurrence or distant metastasis. Learn more 2 Indications for Vascularized Lymph Node Flap Transfer are as follows: Patients exhibiting a total obstruction on lymphoscintigraphy in late grade II, grade III, and IV. Patients without patent lymphatic ducts on indocyanine green lymphography. Learn more 3 Indications for Lymphovenous Anastomoses are as follows: In some cases, surgery may be performed to alleviate swelling and reduce symptoms. Dr. Cheng has developed a unique technique that involves lymph node transfer. During the procedure, Dr. Cheng transfers lymph node flap to distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity. Learn more Lymphedema Treatment Options Accurate diagnosis and appropriate staging assessment are fundamental to the successful treatment of lymphedema. The conventional treatment methods often require the use of antibiotics, massage, and complex decongestive therapy including compression garments and bandages. Innovative surgical treatments have been emerging rapidly in the past 10 years, and the ground breaking vascularized submental lymph node (VSLN) or vascularized groin lymph node (VGLN) flap transfer to distal recipient site that invented by Dr. Cheng create a natural physiologic drainage conduit to alter excess lymphatic fluid buildup and revert side effects like those of tissue fibrosis and skin swelling. Dr. Cheng’s surgical treatment outcomes show significant improvements in the circumferential reduction rates of the affected limb circumference without the use of compression garments. Data source: Asuncion M, Cheng MH, et al. PRS Global Open. 2018;23;6(3):e1691. Cheng MH, et al. Plast. Reconstr. Surg. 2013;131(6):1286-98. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Engel H, Lin CY, Huang JJ, Cheng MH. Ann Surg. 2017 Jun 7. Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

瞭解更多鄭明輝院長首創的淋巴水腫分級評分系統，透過客觀測量和先進的影像技術來分析症狀，能夠精準盤段及確保術後最好的結果。 Cheng Lymphedema Grading Systems Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema Grading Systems Using physical exam findings, history of disease and imaging modalities, several classification schemes have been proposed to stage lymphedema. Perhaps the most widely used is the International Society of Lymphology staging system. But this staging system is based only the clinical symptoms, but no objective measurement or imaging assessment. As our understanding of lymphedema has evolved and technologies improved, other staging systems based on clinical presentation, circumferential measurements, objective measurements, lymphatic imaging or a combination thereof have been proposed. Effective and precise treatment A system adopted by the world At our center, we use the Cheng Lymphedema Grading system based on symptom severity, circumferential difference, and lymphoscintigraphy imaging to determine appropriate treatment, which was published on the Annals of Surgical Oncology, a renowned journal: A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. (Patel KM, Lin CY, Cheng MH.) and book: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015. Cheng Lymphedema Grading English Chinese Upper English Chinese 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. Lower English Chinese 資料來源： Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204. Novel Taiwan Lymphoscintigraphy Staging System Dr. Cheng is the author of the Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging which was published in Annals of Surgery (the top Surgery Journal) in July 2018. The Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging, a comprehensive objective assessment tool that analyzes lymphedema symptoms with quantitative measurements and advanced imaging technology, can effectively help physicians evaluate the severity of lymphatic obstructions, determine the accurate diagnosis, select the most appropriate procedures to treat lymphedema, and ultimately ensure the favorable functional outcome and finest quality of life for lymphedema patients. Taiwan Lymphoscintigraphy Staging English Chinese 資料來源： Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Ann Surg. 2018 Sep;268(3):513-525 Partial obstruction Total obstruction Recommended reading journal A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 https://www.ncbi.nlm.nih.gov/pubmed/25515196 Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Ann Surg. 2018 Sep;268(3):513-525. https://www.ncbi.nlm.nih.gov/pubmed/30004927

Primary Lymphedema 淋巴管靜脈吻合術：​安德森的專業技術， 您的安心選擇及​案例分享 Lymphovenous Anatomosis (LVA) Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema A common problem cancer survivors face is post-operative lymphedema. Lymphedema is caused by excess fluid that collects in the body’s tissue, causing swelling (edema). The symptoms are typically swollen limbs due to lymphatic circulation blockage. Some patients may also experience skin problems (eczema, rough skin, unidentified protrusion), repeated cellulitis or toe mold infection. Award winning plastic surgeon Dr. Cheng specializes in reconstructive surgery and is an expert in the lymphovenous anatomosis (LVA) technique, a minimally-invasive microsurgery procedure that can address the symptoms of lymphedema. Since lymphedema is not always treatable with non-surgical rehabilitation, LVA surgery can greatly improve the condition. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Case 57歲女性，左上肢淋巴水腫12個月 前（左）： 這是一名57歲的女性，在左乳房切除術和放射治療後，左上肢淋巴水腫12個月。 術後（右）： 接受淋巴管靜脈吻合術後，在15個月的隨訪中，不使用壓力袖套，患肢的手臂周長減少率分別為肘部和肘部以下86％和100％。 56歲女性，右上肢淋巴水腫10個月 術前（左）： 這是一名56歲女性，右乳房切除術和腋窩31顆淋巴結廓清術和放射治療後，右上肢淋巴水腫10個月。 術後（右）： 接受淋巴管靜脈吻合術後，在36個月的隨訪中，不使用壓力袖套，患肢的手臂周長減少率分別在肘部和肘部以上100％和100％。 39歲的女性，左上肢淋巴水腫第一級 術前（左）： 39歲的女性，接受過左乳房切除術、清除31顆腋下淋巴結後接受放射線治療，左上肢淋巴水腫第一級，持續6個月。 術後（右）： 接受淋巴管靜脈吻合術，追蹤3個月的結果。不穿戴壓力袖套的狀態下，患肢手臂周長減少率分別為肘上35%及肘下60%。 64歲女性，左上肢淋巴水腫12個月 術前（左）： 這是一名64歲的女性，右乳房切除術和腋窩淋巴結清掃術和放射治療後左上肢淋巴水腫12個月。 術後（右）： 接受淋巴管靜脈吻合術後，在36個月的隨訪中，不使用壓力袖套，患肢的手臂周長減少率分別在肘部和肘部以上100％和100％。 Candidates for LVA Cancer patients that have had lymph nodes removed due to the disease Patients who have not experienced relief from non-surgical therapies Cheng’s grading I, and early grade II lymphedema Partial obstruction on lymphoscintigraphy Patent lymphatic ducts on ICG lymphography Determining a Treatment Plan For patients with grade I to IV lymphedema, an individualized treatment plan is determined based on imaging studies. Patients with grade I and early II lymphedema will undergo a lymphodynamic evaluation by indocyanine green (ICG) lymphography. The ICG injection allows Dr. Cheng to evaluate the presence and location of open, functioning lymphatic channels or dermal backflow (obstruction of lymphatic flow). This type of image study is performed via injections into the second and fourth web spaces of the fingers or toes. Images are obtained at 5 minutes, and then again after 20 hours. These image studies enable Dr. Cheng to create a customized treatment plan for each patient depending on their degree of lymphedema. How Does LVA Surgery Work? The most advanced, minimally invasive super-microsurgical techniques relieve lymphedema through small incisions (around 3cm). Preoperatively, ICG lymphography is used to map the lymphatic system on the skin and locate the incisions. Once the lymphatic channel and a suitable vein have been identified and prepared, a connection between them is created to give the lymphatic fluid an alternative route to escape from the affected area. The lymph fluid will then drain effectively through the vein. Surgical Techniques If LVA surgery is chosen for a patient, Dr. Cheng’s preference is to perform one or two Side-To-End (lymph-to-vein) anastomosis. Using super-microsurgery techniques, Dr. Cheng performs the LVA surgery so that the lymph can drain into the vein from both proximal and distal directions. Into the planned incision, allowing the lymphatic channels to be easily detected. The can then be seen draining from the lymphatic channel into the vein, confirming LVA surgery success. ICG fluorescence may also be used to verify a successful LVA surgery. Side-to-end (Cheng’s Technique) End-to-end (Koshima’s Technique) End-to-end (A and B) end-to-side (C and D) anastomosis are shown. The decision to perform one versus another is based on the intrinsic functionality of the native lymphatic and the inherent pumping mechanism. If the venous pressure is greater than the lymphatic pressure, the blood is regurgitated and causes the anastomosis thrombosis (B and D). Bidirectional lymph will flow into the vein in a side-to-end fashion (C and D). Data source: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 63. Patency test of the side-to-end lymphovenous anastomosis using indocyanine green lymphography (right) and patent blue (left) Q1 What does the lymphatic system do? The lymphatic system is vital to ensure a healthy body. It is responsible for circulating protein-rich lymph fluid though the body. During this process, it collects bacteria, viruses and waste. The fluid gets carried through the lymph vessels to the lymph nodes where the waste is filtered out by infection-fighting cells. The lymphatic system is part of the body's immune system and a crucial aspect of a person's health. Q2 What are the causes of lymphedema? Lymphedema occurs when your lymphatic system is unable to properly drain lymph fluid. While primary lymphedema occurs on its own, secondary lymphedema, which is more common, is caused by a disease or condition. Secondary lymphedema is usually seen when the lymph nodes are removed, oftentimes as part of a cancer treatment. Lymphedema can also be caused by damage to the lymph nodes, from radiation treatment or infection. Should there be a blockage in the lymphatic system, the lymph fluid will not drain well. This leads to fluid buildup and swelling, which generally occurs in the arms and legs. Q3 How can LVA surgery improve lymphedema? LVA surgical approaches, like Dr. Cheng's advanced LVA technique, are effective in reducing or eliminating lymphedema swelling and discomfort. The LVA method directly connects the lymphatic vessels in the affected area to nearby veins. This allows the built-up lymph fluid to drain, which improves the fluid circulation in the body. Typically, LVA is an outpatient procedure, with most patients returning home the same day as the surgery. Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

認識更多原發性淋巴水腫的存在、發展的原因，診斷方式、治療方法，以及為何專業的安德森診所是你最好的選擇。 Primary Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Symptoms of Primary Lymphedema Primary lymphedema is the presence or development of lymphedema without any relation to any underlying medical condition. Primary lymphedema has a quoted incidence of approximately 1-3 births out of every 100,000 births, with a particular female preponderance to male ratio of 3.5:1 worldly. In North America, the incidence of primary lymphedema is approximately 1.15 births out of every 100,000 births. Primary lymphedema can be classified depending on the age of onset of the patients: at infancy (birth to 1 year), during childhood (1-8 or 9 years), during adolescence (9-21 years), and lastly during adulthood (after 21 years). Mutations in VEGFR3 (Milroy disease), CCBE1 (Hennekam syndrome), SOX18 (hypotrichosis-telangiectasia-lymphedema), and FOXC2 (lymphedema distichiasis) are several eponymous conditions that present at birth and involve the development of lymphedema. Familial lymphedema of the lower extremities that presents itself during adolescence is known as Meige disease. Its underlying genetic abnormality is not known yet, but its familial nature and presentation at adolescence are characteristics of it. Primary lymphedema often occurs at birth and for causes or by mechanisms that are unknown. When primary lymphedema becomes symptomatic in adulthood, these patients often have a long-standing history of lymphedema that is associated with the destruction of lymphatic channels. Adipogenesis or proliferation of adipose tissue coupled with dense fibrosis often results in severe lymphedema of the limb and a more severe presentation. Severe fibrosis occurs with long-standing lymphedema due to the accumulation of protein-rich fluid in the interstitial spaces coupled with inflammation repeated bouts of cellulitis. Diagnosis of Primary Lymphedema Pre-operative lymphoscintigraphy and indocyanine green (ICG) lymphography are used to detect the presence of any intact lymphatic channels. If a lymphatic duct is available at ICG lymphography, the patient is offered the lymphovenous anastomosis (LVA), whereas those without patent lymphatic ducts are indicated for vascularized lymph node transfers (VLNT). If the lymphoscintigraphy shown total obstruction, the patients are offered VLNT directly. Ultrasound Doppler is used to evaluate the concomitant vascular lesions at the proximal site. Single-photon emission computed tomography (SPECT) is indicated for those patients with suspected concomitant chylous ascites. MRI is prescribed for the evaluation of donor site lymph node basins of neck if the vascularized lymph node flap is indicated. Lymphoscintigraphy computed tomography (CT) indocyanine green (ICG) lymphography Treatment Of Primary Lymphedema Both Vascularized lymph node transfers (VLNT) and lymphovenous anastomosis (LVA) are surgical treatments that have been proven effective in treating secondary lymphedema. VLNT involves the microsurgical transfer of lymph node-containing tissue to a lymphedematous limb, which works based on the movement of lymphatic fluid from the affected limb into the transferred lymph node and drainage via the newly anastomosed venous route. We have reported a paper to compare the results of VLNT and LVA treatments of lymphedema. 80% of primary lymphedema required a VLNT for the functional recovery and 20% of primary lymphedema may undergo a LVA. At a mean follow-up of 20 months, mean circumferential reduction of limb circumference and episodes of cellulitis were 3.7 ± 2.9 cm and 1.9 ± 2.9 cm; 5.1 ± 2.8 times/year and 4.2 ±0.5 times/year in VLNT and LVA groups, respectively (p = 0.7). Improvements in overall score of the Lymphedema quality of life questionnaire (LYMQoL) (from 3.9 ± 1.2 to 6.4 ± 1.1, p < 0.05) in VLNT group had statistically significant difference than that (from 3.0 ± 1.4 to 5.0 ± 2.4, p=0.07) in LVA group. Both VLNT and LVA surgeries can effectively treat primary lymphedema patients. The reduction of above-knee circumference, body weight, episodes of cellulitis, and the improvement of LYMQoL was significantly greater in LVNT compared to LVA. All of the patients did not use compression garments post-operatively! Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Recommended reading journal Vascularized lymph node flap transfer and lymphovenous anastomosis for klippel-trenaunay syndrome with congenital lymphedema. Qiu SS, Chen HY, Cheng MH. Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e167. https://www.ncbi.nlm.nih.gov/pubmed/25289360 Successful Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema. Charles, Cheng MH. Plast Reconstr Surg Glob Open. 2018 [Epub ahead of print] Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

鄭明輝教授時常受邀至世界各地的教育和醫療機構演講，分享有關淋巴水腫和乳房重建的專業手術技術及研究結果。 Presentations Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 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

瞭解更多安德森整形外科近期的新消息，包括活動資訊、各式療程的知識分享、醫師資訊及其他有關診所的重要資訊 We appreciate the recognition and affirmation from our patients in the United States. Every word of encouragement is our driving force! We are delighted to see Ms. Henry successfully overcome post-breast cancer lymphedema and completely free from compression garments! 💪... Patient testimonials Ming-huei Cheng Dec 17, 2024 0 Post not marked as liked Professor Cheng was invited to attend the 49th Global Plastic Surgery Conference held in Porto, Portugal. It was a great honor to be invited by Dr. Manuel Caneiro and Dr. Alvaro Silva to attend the 49th Global Plastic Surgery Conference held... Presentations Ming-huei Cheng Dec 10, 2024 1 Post not marked as liked Gratitude from Canada — A Patient's Kindness Warms Our Hearts This week, Anderson received a thank-you card that warmed the hearts of all our medical staff. This card was not just a simple greeting... Ming-huei Cheng Sep 26, 2024 0 Post not marked as liked Congratulations to Dr. Cheng for being recognized among the top 2% of scientists worldwide! I'm thrilled to share that Stanford University has released its 2024 list of the 'Top 2% Scientists in the World,' recognizing the top 2%... Ming-huei Cheng Sep 25, 2024 0 Post not marked as liked The 10th World Symposium for Lymphedema Surgery (WSLS) was successfully concluded The 10th World Lymphedema Symposium was held at Taipei Garden Hotel on April 22-24. The Anderson team, led by Dean Zheng Minghui, spent... Lymphedema Ming-huei Cheng Apr 24, 2024 0 Post not marked as liked Congratulation! The Spanish version of Lymphedema Surgery textbook has been published It is my privilege to announce the Spanish version of our Lymphedema Surgery textbook has been published. I would like to give special... Lymphedema Ming-huei Cheng Apr 30, 2022 0 Post not marked as liked Dr.Cheng gave A Virtual Visiting Professor Lecture at The University of California, Los Angeles (UCLA) I have appreciated the opportunity to give a virtual visiting professor lecture for UCLA today. It brought back memories of the training... Presentations Ming-huei Cheng Aug 12, 2020 0 Post not marked as liked Dr.Cheng Presented at The 2020 Virtual Duke Flap Course Feel so privileged to be part of the renowned training program with many amazing and talented surgical experts at the 2020 Virtual Duke... Presentations Ming-huei Cheng Aug 2, 2020 0 Post not marked as liked Dr. Cheng Presented at 2020 American Society of Reconstructive Microsurgery (ASRM) Annual Meeting Very happy to have managed to attend the 2020 American Society of Reconstructive Microsurgery (ASRM) Annual Meeting at Marriott Harbor... Presentations Ming-huei Cheng Jan 12, 2020 0 Post not marked as liked Congratulation! Papers Published in the Journal Surgical Oncology I want to express my sincere appreciation to the Editor-in-Chief Dr. Stephen Sener of Journal Surgical Oncology, and the co-guest editors... Ming-huei Cheng Dec 19, 2019 0 0 comments 0 Post not marked as liked Congratulation! Two Papers Published in Plastic Reconstructive Surgery I feel so happy and humbled to share the great news that two research papers were recently published in the October Issue at Plastic... Ming-huei Cheng Nov 15, 2019 0 Post not marked as liked Raises Breast Reconstruction Awareness in October It was a great pleasure and honor to share my journey as a surgeon of breast constructions at the grand round of our Department at CGMH... Ming-huei Cheng Oct 16, 2019 0 Post not marked as liked