DR. MICHEL ALAIN DANINO IN THE MEDIA
Throughout his professional career, Dr. Michel Alain Danino has been contributing to the technological advancement of plastic surgery's practices. Below, you will find news articles and social media mentions talking about Dr. Michel Alain Danino's direct implication into his field of expertise.
Traditional Media
Breakthrough surgery at CHUM helps lymphedema patients - Aaron Derfel, Montreal Gazette
A first at CHUM: supermicrosurgery - Radio-Canada
Read the article
The University Hospitals of Martinique and Montreal are developing a new technique in breast reconstruction - Martinique la 1ère
Watch the video
Report on breast reconstruction in Martinique. A collaboration between the CHUM Martinique University Antilles Guyane and the CHUM
Social Media
LIPOPENOSCULPTURE, OR LPS
Penile surgery has two components that can be easily combined: thickening and lengthening.
THICKENING LPS
For decades, liquid silicone and other fillers have been used to thicken the penis. These methods were ineffective and often harmful due to the formation of granulomas or migration of the product.
Today, autologous adipose tissue transplantation, which is effective and harmless, has proven to be the most reliable and least dangerous.
EXTRACTION OF ADIPOCYTES
It is done at the pubic area, the inner and outer region of the thighs, the abdomen or sometimes the buttocks.
Indeed, these sites are rich in adipocytes with a2 receptors, which are not very sensitive to diet and weight variations, unlike adipocytes with b1 receptors (arms, thorax), allowing better maintenance of the graft over time.
PLACEMENT OF THE GRAFT
We use a 1.2 mm diameter cannula. The cannula is mounted on a 10 ml syringe, placed in a device designed for this purpose, of the gun type, whose barrel notches allow, with low and equal pressure, a harmonious, uniform distribution of the needle and good control of its contours.
The entry points, two in number, are located in the ventral and distal part of the body of the penis, in the preputial skin or in the balanopreputial groove. We chose the entry points at the level of the balanopreputial groove, immediately below the glans, because we are naturally in the correct anatomical plane; moreover, the maneuver is easier than by a penopubic approach. The transplant is placed up to the base of the penis, at its pubic angle; it must be deposited according to parallel trabeculae in each histological layer, between the skin and the tunica albuginea, respecting the integrity of the dartos and Buck's fascia.
The deposition consists of seeding subcutaneous islets, in equal quantities, of 0.5 cm³ on average, placed in superimposed trabeculae along a flaccid penis, respecting the integrity of these envelopes. It is important not to provide too large quantities of fat at the same time in order to limit the occurrence of cytosteatonecrosis which could have an unsightly and annoying effect for the patient. The usual quantity grafted is 50 to 70 cm³. The following times, 70% of the previous graft is grafted. It is also important not to place the fat too superficially in order to avoid any risk of necrosis.
LPS EXTENSION
Penis enlargement occurred later, around the 1980s, and is the result of the detachment of the corpora cavernosa from their pubic bone attachments, by section of the suspensory ligament. The practice of these interventions has made it possible to make the techniques more reliable and standardized.
The surgical lengthening procedure consists of a partial section of the suspensory ligament of the penis, a dissection and incision of the superficial parts of the medial and lateral bundles of the ligament and a skin plastic surgery.
After taking the width of the penis at its base as a reference, we draw two vertical lines one centimeter upwards at its two ends, which we join with a horizontal line. We incise the skin along these lines, then we extend the incisions, also one centimeter, downwards on each side. We make two horizontal incisions at the level of the natural penopubic folds. Once the skin is incised, the two lateral counter-incisions open and allow a first tilt of the penis downwards. We dissect between the spermatic cords, which we take care to respect, to reach the bundles of the suspensory ligament which we cut while remaining in contact with the pubic bone.
Having estimated the maximum detachment in the space thus created, this empty space between the bone and the corpora cavernosa is filled by bringing the funicular fat closer together, so as to create a cushion that will prevent any secondary adhesion between the bone and the corpora cavernosa. The cutaneous plane is closed by suturing the lateral angles of the initial incision to the external end of the lateral counter-incisions. This phase of skin plastic surgery is essential to perpetuate the downward tilt of the initial incision. Ultimately, the scar will consist of a median vertical branch and two lateral branches at the level of the body of the penis.
Global LPS is performed under general anesthesia in outpatient surgery, it lasts on average 30 minutes. The dressing is made with non-compressive tulle gras, under antibiotic cover. It is renewed daily for five days.
Sexual rest is recommended, one month after the global LPS, two weeks after the thickening alone. Patients are reviewed the next day, at one week, one month, three months and one year. The main criteria for satisfaction apart from the global penile enlargement, are the preservation of a natural appearance, identical sensitivity and an absence of discomfort during sexual intercourse.
POSSIBLE COMPLICATIONS
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Irrégularité de la prise de la greffe
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Troubles esthétiques liés à cette prise de la greffe irrégulière
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Échec de la prise de la greffe de graisse
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Œdèmes fréquents (27 % des cas) et sans conséquence. Pour les patients non circoncis, ils doivent être informés qu’un possible œdème pourrait les empêcher de décalotter aisément leur verge durant trois à cinq semaines.
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Désunions de cicatrice (10 % des cas) qui cicatrisent en quelques jours
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Nécrose cutanée, très rare
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Infections dont le patient ne conserve aucune séquelle
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Fibrose, calcifications, ou kystes graisseux
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Granulomes dus à la cytostéatonécrose