Dr. Dung H Nguyen is currently the Director of Breast Reconstruction at the Stanford Women’s Cancer Center and the Director of Adult Plastics Clinic at Stanford Healthcare. She graduated with a Bachelor of Science in Biochemistry and highest academic honor and distinction from U.C. Davis. She earned a Pharm.D degree from U.C.S.F. School of Pharmacy and a MD degree from U.C.S.D. She then did a residency in general surgery and a residency in Plastic and Reconstructive Surgery at the University of Southern California (USC) Medical Center. She further completed a fellowship in microsurgery from Chang Gung Memorial Hospital in Taiwan, one of the largest reconstructive surgery centers in the world. She was recruited to Stanford from Cedar Sinai Medical Center in 2012, and is currently a Clinical Associate Professor in the Division of Plastic and Reconstructive Surgery at Stanford University.
Dr. Nguyen specializes in aesthetic and reconstructive breast surgery, surgical treatment of lymphedema including vascularized lymph node transfer and lymphaticovenous anastomosis, and complex tissue reconstruction utilizing microsurgery and supermicrosurgery. She also has interest in cosmetic surgery, including facial rejuvenation and body contouring procedures.
In addition to her clinical commitment, Dr. Nguyen has basic science and clinical research interests in lymphedema and breast reconstruction. She has published articles in peer review journals, presented at national and international professional meetings and has authored book chapters in various plastic surgery textbooks. She also enjoys volunteering on overseas medical missions and participating in medical charity activities.
- Cancer > Breast Cancer
- Plastic and Reconstructive Surgery
- Skin Cancer
- Facial and Body Rejuvenation
- Transgender Surgery
Clinical Associate Professor, Surgery - Plastic & Reconstructive Surgery
Director of Breast Reconstruction, Stanford Women's Cancer Center (2012 - Present)
Director of Adult Plastics Clinic, Stanford Healthcare (2016 - Present)
Honors & Awards
Division of Plastic & Reconstructive Surgery Teacher of the Year Award, Stanford University (2017)
Innovation Grant for Breast Reconstruction, Stanford Women's Cancer Center (2016)
Residency:Univ of Southern CA/LACplusUSC Medical Center (2010) CA
Residency:Univ of Southern CA/LACplusUSC Medical Center (2007) CA
Medical Education:University of California San Diego School of Medicine Registrar (2004) CA
Board Certification: Plastic and Reconstructive Surgery, American Board of Plastic Surgery (2012)
Board Certification, Board of Pharmacy, CA (2003)
Fellowship, Chang Gung Memorial Hospital, Taiwan, Microsurgery (2011)
Residency, USC, Plastic & Reconstructive Surgery (2010)
Residency, USC, General Surgery (2007)
M.D., UCSD School of Medicine, CA (2004)
Pharm.D., UCSF School of Pharmacy, CA (2000)
A Study of the Safety and Effectiveness of the Mentor Larger Size MemoryGel Ultra High Profile Breast Implants in Subjects Who Are Undergoing Primary Breast Reconstruction or Revision Reconstruction
The study will evaluate the safety and effectiveness with the Mentor MemoryGel® Larger Size Ultra High Profile (UHP-L) Breast Implants.
Study to Evaluate the Safety and Efficacy of CHAM* for the Treatment of Diabetic Foot Ulcers
A Multicenter, Randomized, Single-Blind Study with an Open-Label Extension Option to Further Evaluate the Safety and Efficacy of Cryopreserved Human Amniotic Membrane for the Treatment of Chronic Diabetic Foot Ulcers
Transversus Abdominis Plane Block in Microsurgical Breast Recon w/Abdominal Free Flap in Breast CA
The purpose of this trial is to determine if using abdominal nerve blocks when patient undergo breast reconstruction can significantly decrease use of pain medications after reconstructive surgery.
Microsurgical Breast Reconstruction & VTE
Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep venous thrombosis (DVT) and continues to be a major patient safety issue after reconstructive plastic surgery. Significant morbidity and mortality is associated with VTE events. This disease entity represents the most common cause of preventable in-hospital death as evidenced by over 100,000 annual VTE-related deaths in the U.S. The associated economic burden is substantial, with annual costs to the U.S. healthcare system in excess of $7 billion. Cancer patients have been identified as a particularly vulnerable patient population. Of these, breast cancer patients represent the largest group treated by plastic surgeons. An increasing number of breast reconstructions are performed in the U.S. with a documented 35% increase in the annual number of breast reconstructions since 2000. Over 106,000 breast reconstructions were performed in 2015 alone. Of all reconstructive modalities, autologous breast reconstruction using abdominal flaps is associated with the highest risk for VTE. We believe that a key element rendering these patients susceptible to postoperative VTE is inadequate duration of chemoprophylaxis. This is supported by the observation that VTE risk remains elevated for up to 12 weeks postoperatively. We hypothesize that lower extremity deep venous system stasis is a procedure-specific key contributing factor to postoperative VTE risk. This study examines the duration of postoperative lower extremity venous stasis to identify patients who might benefit from extended chemoprophylaxis. We will use Duplex imaging technology to examine the lower extremity deep venous system preoperatively, on postoperative day 1, and on the day of discharge to determine if patients display radiographic evidence of lower extremity venous stasis at the time of hospital discharge. A better understanding of pathophysiologic mechanisms that contribute to the development of VTE as well as surgical means that reduce VTE risk factors have the potential to optimize VTE prophylaxis, thus, favorably impacting clinical outcome in a large patient population.
Stanford is currently not accepting patients for this trial. For more information, please contact Arash Momeni, MD, 650-723-6189.
Prospective Evaluation of the Biobridge Scaffold as an Adjunct to Lymph Node Transfer for Upper Extremity Lymphedema
To investigate whether addition of the Biobridge scaffold to the standard surgery for vascularized lymph node transfer will improve the outcome of surgical treatment in lymphedema of the upper arm.
Stanford is currently not accepting patients for this trial. For more information, please contact Eric Henderson, 650-723-1396.
SPY Intra-Operative Angiography & Skin Perfusion in Immediate Breast Reconstruction w/ Implants
The investigators hope to learn the value of the SPY ELITE® intra-operative angiography in reducing post-operative complications associated with low breast skin blood flow after breast reconstruction using implants.
Stanford is currently not accepting patients for this trial. For more information, please contact Shannon Meyer, 650-724-1953.
Correction of complete thoracic duct obstruction with lymphovenous bypass: A case report.
Thoracic duct injury can be a devastating injury with disruption of lymphatic flow leading to potentially chylothorax and/or severe lymphedema. Standard treatment modalities include thoracic duct ligation or embolization for chylothorax, but treatment options to date are few for resultant lymphedema. In this case report, we describe lymphaticovenous bypass of the thoracic duct to the jugular venous system in a 21-year-old male with secondary lymphedema after iatrogenic thoracic duct injury. The patient experienced improvement of lymphedema symptoms including decreased weight and limb girth as well as normalization of serum markers indicating improved lymphatic delivery to the venous system. Lymphangiogram at 3 months post op demonstrated patency of the lymphaticovenous anastomoses. At 6-month follow-up, the patient had returned to his preoperative level of activity and showed continued improvement of his lymphedema symptoms. Lymphovenous bypass of the thoracic duct may be an effective technique to treat secondary lymphedema from thoracic duct obstruction, though further studies are required to determine long-term efficacy.
View details for PubMedID 29974499
Deepithelialized Skin Reduction Preserves Skin and Nipple Perfusion in Immediate Reconstruction of Large and Ptotic Breasts.
Annals of plastic surgery
BACKGROUND: Women with large and/or ptotic breasts are often not considered candidates for nipple-sparing mastectomy (NSM) and/or immediate breast reconstruction given difficulties avoiding ischemic complications and achieving a favorable aesthetic result. We report a novel technique involving deepithelialized skin reduction to simultaneously reduce the skin envelope and preserve perfusion to the skin and nipple in immediate breast reconstruction for women that fit this high-risk anatomic profile.METHODS: We reviewed cases of NSM and skin-sparing mastectomy (SSM) with immediate implant-based and free autologous reconstruction by a single plastic surgeon from 2013 to 2017. All patients had at least size C cup breasts (>500 g) and/or grade 3 ptosis. Select patients undergoing NSM had devascularization of the nipple-areolar complex (NAC) 1 to 2 months before surgery to promote adaptive circulatory change. After mastectomy, skin reductions were performed via Wise, periareolar, or circumareolar reduction patterns, with infolding of a deepithelialized inferior and periareolar skin flap over a tissue expander or free flap. In NSM, the nipple was advanced superiorly and redirected through a keyhole of deepithelialized skin flap.RESULTS: Patients had an average age of 43.6 years and body mass index of 27.7. A total of 33 breasts in 19 patients (14 bilateral, 5 unilateral) underwent deepithelialized skin reduction. There were 14 NSM and 19 SSM. Reconstructions consisted of 13 tissue expanders exchanged to implants and 20 abdominally-based free flaps. Four patients underwent devascularization of the NAC before NSM. Six (18%) breasts had partial thickness flap loss that healed by delayed primary (n = 1) or secondary (n = 5) intention. Four nipples, all in patients without prior NAC devascularization, had ischemic complications (2 epidermolysis, 12.5%; 2 partial necrosis, 12.5%), which all healed by secondary intention with the exception of 1 case of NAC removal.CONCLUSIONS: Skin reduction with deepithelialization and tissue infolding preserves dermal plexus perfusion and promotes nipple and skin flap survival in immediate implant-based and autologous breast reconstruction after SSM and NSM. This technique can be combined with NAC devascularization to further promote nipple perfusion. Overall, this method offers an acceptable complication rate and the potential to expand the reconstructive options available to women with large and/or ptotic breasts.
View details for DOI 10.1097/SAP.0000000000001427
View details for PubMedID 29746276
Deferoxamine Preconditioning of Irradiated Tissue Improves Perfusion and Fat Graft Retention
PLASTIC AND RECONSTRUCTIVE SURGERY
2018; 141 (3): 655–65
Radiation therapy is a mainstay in the treatment of many malignancies, but collateral damage to surrounding tissue, with resultant hypovascularity, fibrosis, and atrophy, can be difficult to reconstruct. Fat grafting has been shown to improve the quality of irradiated skin, but volume retention of the graft is significantly decreased. Deferoxamine is a U.S. Food and Drug Administration-approved iron-chelating medication for acute iron intoxication and chronic iron overload that has also been shown to increase angiogenesis. The present study evaluates the effects of deferoxamine treatment on irradiated skin and subsequent fat graft volume retention.Mice underwent irradiation to the scalp followed by treatment with deferoxamine or saline and perfusion and were analyzed using laser Doppler analysis. Human fat grafts were then placed beneath the scalp and retention was also followed up to 8 weeks radiographically. Finally, histologic evaluation of overlying skin was performed to evaluate the effects of deferoxamine preconditioning.Treatment with deferoxamine resulted in significantly increased perfusion, as demonstrated by laser Doppler analysis and CD31 immunofluorescent staining (p < 0.05). Increased dermal thickness and collagen content secondary to irradiation, however, were not affected by deferoxamine (p > 0.05). Importantly, fat graft volume retention was significantly increased when the irradiated recipient site was preconditioned with deferoxamine (p < 0.05).The authors' results demonstrated increased perfusion with deferoxamine treatment, which was also associated with improved fat graft volume retention. Preconditioning with deferoxamine may thus enhance fat graft outcomes for soft-tissue reconstruction following radiation therapy.
View details for PubMedID 29135894
Successful management of persistent lower extremity lymphedema with suction-assisted lipectomy
GYNECOLOGIC ONCOLOGY REPORTS
2018; 23: 13–15
Lower-extremity lymphedema is a significant complication attributed to gynecologic cancer surgery, potentially effectuating severe edema and discernible pain.We report on a patient who developed persistent, lower-extremity lymphedema following her treatment for cervix cancer. Despite repeated efforts to manage the lymphedema with conventional measures, the patient's condition had not markedly improved. Thereafter, she underwent a suction-assisted lipectomy that effectively resolved her symptoms.Since lymphedema often remains disabling and incurable following traditional therapy, suction-assisted lipectomy should be considered as an alternative when endeavoring to optimally manage this complication.
View details for DOI 10.1016/j.gore.2017.12.004
View details for Web of Science ID 000432543200005
View details for PubMedID 29322088
View details for PubMedCentralID PMC5755744
Breast Augmentation and Breast Reconstruction Demonstrate Equivalent Aesthetic Outcomes.
Plastic and reconstructive surgery. Global open
2016; 4 (7)
There is a perception that cosmetic breast surgery has more favorable aesthetic outcomes than reconstructive breast surgery. We tested this hypothesis by comparing aesthetic outcomes after breast augmentation and reconstruction.Postoperative images of 10 patients (cosmetic, n = 4; reconstructive, n = 6; mean follow-up, 27 months) were presented anonymously to participants who were blinded to clinical details. Participants were asked if they believed cosmetic or reconstructive surgery had been performed. Aesthetic outcome measures were quantified: (1) natural appearance, (2) size, (3) contour, (4) symmetry, (5) position of breasts, (6) position of nipples, (7) scars (1 = poor and 4 = excellent). Images were ranked from 1 (most aesthetic) to 10 (least aesthetic). Analyses included two-tailed t tests, Mann-Whitney U tests, and χ(2) tests.One thousand eighty-five images were quantified from 110 surveys (99% response rate). The accuracy of identifying cosmetic or reconstructive surgery was 55% and 59%, respectively (P = 0.18). Significantly more of the top 3 aesthetic cases were reconstructive (51% vs 49%; P = 0.03). Despite this, cases perceived to be reconstructive were ranked significantly lower (5.9 vs 5.0; P < 0.0001). Mean aesthetic outcomes were equivalent regardless of surgery for 5 categories (P > 0.05), with the exception of breast position that improved after reconstruction (2.9 vs 2.7; P = 0.009) and scars that were more favorable after augmentation (2.9 vs 3.1; P < 0.0001). Age and nipple position (R (2) = 0.04; P = 0.03) was the only association between a demographic factor and aesthetic outcome.Aesthetic outcomes after cosmetic and reconstructive breast surgery are broadly equivalent, though preconceptions influence aesthetic opinion. Plastic surgeons' mutually inclusive-reconstructive and aesthetic skill set maximizes aesthetic outcomes.
View details for DOI 10.1097/GOX.0000000000000824
View details for PubMedID 27536490
View details for PubMedCentralID PMC4977139
Use of Indocyanine Green-SPY Angiography for Tracking Lymphatic Recovery After Lymphaticovenous Anastomosis.
Annals of plastic surgery
2016; 76: S232-7
Lymphaticovenous anastomosis (LVA) is a surgical treatment option for patients with early stage lymphedema. To date, no ideal imaging modality exists for tracking patency of the LVA postoperatively. We hypothesize that laser angiography utilizing indocyanine green (ICG) via the SPY system (Lifecell Corp.) would be a useful methodology for assessing the patency of the LVA and lymphatic recovery postoperatively.A prospective trial was performed on patients with stage II lymphedema who underwent LVA from 2013 to 2014 by a single surgeon. All candidates underwent preoperative and postoperative lymphatic mapping using ICG-SPY angiography. Postoperative analyses were performed at 1 month and at 9 months after surgery and assessed for patency at the site of the LVAs and for changes in lymphatic pattern.Five patients underwent LVA, 3 for upper extremity and 2 for lower extremity stage II lymphedema. The number of LVAs per extremity was 1 to 3 (total, 11). One month postoperative ICG-SPY angiography demonstrated flow through 9 of 11 anastomoses. Evaluation at 9 months postoperative showed improvement in lymphatic drainage.Indocyanine green-SPY angiography may be used to objectively evaluate the surgical outcome of LVA.
View details for DOI 10.1097/SAP.0000000000000766
View details for PubMedID 27070461
Using intraoperative laser angiography to safeguard nipple perfusion in nipple-sparing mastectomies.
2015; 4 (6): 497-505
The superior aesthetic outcomes of nipple-sparing mastectomies (NSM) explain their increased use and rising popularity. Fortunately, cancer recurrences involving the nipple-areolar complex (NAC) have been reassuringly low in the range of 1%. Technical considerations and challenges of this procedure are centered on nipple ischemia and necrosis. Patient selection, reconstructive strategies and incision placement have lowered ischemic complications. In this context, rates of full NAC necrosis are 3% or less. The emergence of noninvasive tissue angiography provides surgeons with a practical tool to assess real-time breast skin and NAC perfusion. Herein, we review our classification system of NAC perfusion patterns defined as V1 (from subjacent breast), V2 (surrounding skin), and V3 (combination of V1 + V2). Additionally, we describe the benefits of a first stage operation to devascularize the NAC as a means of improving blood flow to the NAC in preparation for NSM, helping extend the use of NSM to more women. Intraoperative evaluation of skin perfusion allows surgeons to detect ischemia and modify the operative approach to optimize outcomes.
View details for DOI 10.3978/j.issn.2227-684X.2015.04.15
View details for PubMedID 26645004
Motion Analysis for Microsurgical Training: Objective Measures of Dexterity, Economy of Movement, and Ability.
Plastic and reconstructive surgery
2015; 136 (2): 231e-40e
Evaluation of skill acquisition in microsurgery has traditionally relied on subjective opinions of senior faculty, but is shifting toward early competency-based training using validated models. No objective measures of dexterity, economy of movement, and ability exist. The authors propose a novel video instrument motion analysis scoring system to objectively measure motion.Video of expert microsurgeons was analyzed and used to develop a resident motion analysis scoring system based on a mathematical model. Motion analysis scores were compared to blinded, global rating scores of the same videos using the Stanford Microsurgery and Resident Training scale.Eighty-five microsurgical anastomoses from 16 residents ranging from postgraduate years 1 through 6 were analyzed. Composite motion analysis scores for each segmented video correlated positively to arterial anastomotic experience (rho, +0.77; p < 0.001). Stanford Microsurgery and Resident Training scale interrater reliability was consistent between expert assessors, and mean composite motion analysis overall performance and Stanford scores were well matched for each level of experience. Composite motion analysis scores correlated significantly with combined Stanford Microsurgery and Resident Training [instrument handling (rho, +0.66; p < 0.01), efficiency (rho, +0.59; p < 0.01), suture handling (rho, +0.83; p < 0.001), operative flow (rho, +0.67; p < 0.001), and overall performance (rho, +89; p < 0.001)] motion components of the scale.Instrument motion analysis provides a novel, reliable, and consistent objective assessment for microsurgical trainees. It has an associated cost, but is timely, repeatable, and senior physician independent, and exposes patients to zero risk.
View details for DOI 10.1097/PRS.0000000000001469
View details for PubMedID 26218398
- Using intraoperative laser angiography to safeguard perfusion in nipple-sparing mastectomies. Gland Surgery Journal 2015
Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats
This study was conducted to investigate the correlation between the number of vascularized lymph nodes (LN) transferred and resolution of hind limb lymphedema in a rat model.Unilateral hind limb lymphedema was created in 18 male Sprague-Dawley rats following inguinal and popliteal LN resection and radiation. A para-aortic LN flap based on the celiac artery was subsequently transferred to the affected groin. The three study groups consisted of Group A (no LN transfer), Group B (transfer of a single vascularized LN), and Group C (transfer of three vascularized LNs). Volumetric analysis of bilateral hind limbs was performed using micro-CT imaging at 1, 2, and 3 months postoperatively. Lymphatic drainage was assessed with Tc(99) lymphoscintigraphy preoperatively and at 3 months postoperatively.A statistically significant volume reduction was seen in Groups B and C compared to Group A at all time points. Volume reduction of Group A vs.Group B at 1 month (8.6% ± 2.0% vs. 2.7% ± 2.6%, P < 0.05), 2 months (9.3% ± 2.2% vs. -4.3% ± 2.7%, P < 0.05), and 3 months (7.6% ± 3.3% vs. -8.9% ± 5.2%, P < 0.05). Volume reduction of Group A vs. Group C at 1 month (8.6% ± 2.0% vs. -6.6% ± 3.1%, P < 0.05), 2 months (9.3% ± 2.2% vs. -10.2% ± 4.6%, P < 0.05), and 3 months (7.6% ± 3.3% vs. -9.1% ± 3.1%, P < 0.05). Of note, comparison of Groups B and C demonstrated greater volume reduction in Group C at 1 (P < 0.02) and 2 (P = 0.07) months postoperatively.LN flap transfer is an effective procedure for the treatment of lymphedema. The number of vascularized LNs transferred correlates positively with the degree of volume reduction. © 2015 Wiley Periodicals, Inc. Microsurgery 36:239-245, 2016.
View details for DOI 10.1002/micr.22388
Developing a Lower Limb Lymphedema Animal Model with Combined Lymphadenectomy and Low-dose Radiation.
Plastic and reconstructive surgery. Global open
2014; 2 (3)
This study was aimed to establish a consistent lower limb lymphedema animal model for further investigation of the mechanism and treatment of lymphedema.Lymphedema in the lower extremity was created by removing unilateral inguinal lymph nodes followed by 20, 30, and 40 Gy (groups IA, IB, and IC, respectively) radiation or by removing both inguinal lymph nodes and popliteal lymph nodes followed by 20 Gy (group II) radiation in Sprague-Dawley rats (350-400 g). Tc(99) lymphoscintigraphy was used to monitor lymphatic flow patterns. Volume differentiation was assessed by microcomputed tomography and defined as the percentage change of the lesioned limb compared to the healthy limb.At 4 weeks postoperatively, 0% in group IA (n = 3), 37.5% in group IB (n = 16), and 50% in group IC (n = 26) developed lymphedema in the lower limb with total mortality and morbidity rate of 0%, 56.3%, and 50%, respectively. As a result of the high morbidity and mortality rates, 20 Gy was selected, and the success rate for development of lymphedema in the lower limb in group II was 81.5% (n = 27). The mean volume differentiation of the lymphedematous limb compared to the health limb was 7.76% ± 1.94% in group II, which was statistically significant compared to group I (P < 0.01).Removal of both inguinal and popliteal lymph nodes followed by radiation of 20 Gy can successfully develop lymphedema in the lower limb with minimal morbidity in 4 months.
View details for DOI 10.1097/GOX.0000000000000064
View details for PubMedID 25289315
View details for PubMedCentralID PMC4174147
- A Novel Approach to the Treatment of Lower Extremity Lymphedema by Transferring a Vascularized Submental Lymph Node Flap to the Ankle. Gynecologic Oncology 2012; 126: 93-98
- Anatomical Basis and Clinical Application of the Ulnar Forearm Free Flap for Head and Neck Reconstruction. The Laryngoscope 2012; 122 (12): 2670-6
- Simultaneous Left Maxillary and Right Mandibular Reconstructions Using Split Osteomyocutaneous Peroneal Artery-based Combined Flaps. Head and Neck 2011; 10: 1002-5
- Simultaneous Scarless Contralateral Breast Augmentation During Unilateral Breast Reconstruction Using Differentially Split DIEP Flaps. Plastic Reconstructive Surgery 2011; 12 (6): 593e-604e
- A novel approach to cervical reconstruction using vaginal mucosa-lined polytetrafluoroethylene graft in congenital agenesis of the cervix. Fertility and Sterility 2011; 95 (7): 2433.e5-8
- Simultaneous Contralateral Breast Reduction/Mastopexy with Unilateral Breast Reconstruction Using Free Abdominal Flaps. Annals of Plastic Surgery 2011: 336-42
- How to Harvest a Fibula Flap in 45 Minutes. Plastic Surgery Pulse News 2011; 3 (2)
- A Novel Approach to Acute Infection of the Glenohumeral Joint Following Rotator Cuff Repair – A case series. Wounds 2005; 17 (6): 137-140
- Estrogen Accelerates the Development of Renal Disease in Female Obese Zucker Rats. Kidney International 1998; 53 (1): 130-5