Bio

Clinical Focus


  • Cancer > Breast Cancer
  • Plastic and Reconstructive Surgery
  • Lymphedema
  • Skin Cancer
  • Facial and Body Rejuvenation

Academic Appointments


Administrative Appointments


  • Director of Breast Reconstruction, Stanford Women's Cancer Center (2012 - Present)

Professional Education


  • Medical Education:University of California San Diego School of Medicine (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)

Publications

All Publications


  • Breast Augmentation and Breast Reconstruction Demonstrate Equivalent Aesthetic Outcomes. Plastic and reconstructive surgery. Global open Rochlin, D. H., Davis, C. R., Nguyen, D. H. 2016; 4 (7)

    Abstract

    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

  • Use of Indocyanine Green-SPY Angiography for Tracking Lymphatic Recovery After Lymphaticovenous Anastomosis. Annals of plastic surgery Shih, H. B., Shakir, A., Nguyen, D. H. 2016; 76: S232-7

    Abstract

    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. Gland surgery Dua, M. M., Bertoni, D. M., Nguyen, D., Meyer, S., Gurtner, G. C., Wapnir, I. L. 2015; 4 (6): 497-505

    Abstract

    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 McGoldrick, R. B., Davis, C. R., Paro, J., Hui, K., Nguyen, D., Lee, G. K. 2015; 136 (2): 231E-240E

    Abstract

    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 Web of Science ID 000359715200001

  • Using intraoperative laser angiography to safeguard perfusion in nipple-sparing mastectomies. Gland Surgery Journal Dua, M., Bertoni, D., Nguyen, D. H., Meyer, S., Gurtner, G., Wapnir, I. 2015
  • Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats Microsurgery Nguyen, D. H., Chou, P. Y., Hsieh, Y. H., Momeni, A., Fang, Y. D., Patel, K. M., Yang, C. Y., Ko, Y. S., Cheng, M. H. 2015

    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 Yang, C., Nguyen, D. H., Wu, C., Fang, Y. D., Chao, K., Patel, K. M., Cheng, M. 2014; 2 (3)

    Abstract

    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

  • A Novel Approach to the Treatment of Lower Extremity Lymphedema by Transferring a Vascularized Submental Lymph Node Flap to the Ankle. Gynecologic Oncology Cheng, M. H., Huang, J. J., Nguyen, D. H., Saint-Cyr, M., Zenn, M. R., Tan, B. K., Lee, C. L. 2012; 126: 93-98
  • Anatomical Basis and Clinical Application of the Ulnar Forearm Free Flap for Head and Neck Reconstruction. The Laryngoscope Huang, J. J., Lam, W. L., Phil, M., Nguyen, D. H., Wu, C. W., Kao, H. K., Lin, C. Y., Cheng, M. H. 2012; 122 (12): 2670-6
  • Simultaneous Left Maxillary and Right Mandibular Reconstructions Using Split Osteomyocutaneous Peroneal Artery-based Combined Flaps. Head and Neck Nguyen, D. H., Wu, C. W., Huang, J. J., Cheng, M. H. 2011; 10: 1002-5
  • Simultaneous Scarless Contralateral Breast Augmentation During Unilateral Breast Reconstruction Using Differentially Split DIEP Flaps. Plastic Reconstructive Surgery Huang, J. J., Chao, L. F., Wu, C. W., Nguyen, D. H., Valerio, I. L., Cheng, M. H. 2011; 12 (6): 593e-604e
  • How to Harvest a Fibula Flap in 45 Minutes. Plastic Surgery Pulse News Nguyen, D. H., Lin, C. H. 2011; 3 (2)
  • Simultaneous Contralateral Breast Reduction/Mastopexy with Unilateral Breast Reconstruction Using Free Abdominal Flaps. Annals of Plastic Surgery Huang, J. J., Wu, C. W., Lam, W. L., Lin, C. Y., Nguyen, D. H., Cheng, M. H. 2011: 336-42
  • A novel approach to cervical reconstruction using vaginal mucosa-lined polytetrafluoroethylene graft in congenital agenesis of the cervix. Fertility and Sterility Nguyen, D. H., Lee, C. L., Wu, K. Y., Cheng, M. H. 2011; 95 (7): 2433.e5-8
  • A Novel Approach to Acute Infection of the Glenohumeral Joint Following Rotator Cuff Repair – A case series. Wounds Dobke, M. K., Nguyen, D. H., Trott, S. A. 2005; 17 (6): 137-140
  • Estrogen Accelerates the Development of Renal Disease in Female Obese Zucker Rats. Kidney International Gades, M. D., Sterns, J. S., van Goor, H., Nguyen, D. H., Johnson, P. R., Kaysen, G. A. 1998; 53 (1): 130-5