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Keyhole Top Surgery Before and After: A Comprehensive Guide

Medically reviewed by Jennifer Richman on October 09, 2024.

Understanding Keyhole Top Surgery

Keyhole top surgery refers to a technique that creates a flat chest by removing tissue through a small incision made around the lower half of the areola. This procedure is ideal for patients with very minimal chest tissue and relatively elastic skin, which is an estimated 5% of the population. This is because no excess skin is removed. As a result, scarring is minimal in this procedure. With proper care, the appearance of the scars becomes hidden in the areola, making them practically invisible. Below you can find pictures and information on keyhole top surgery before and after results.

Results and Satisfaction

The following before and after photos demonstrate the results of keyhole top surgery. Note that some results show patients at their first post-op appointment, about 6-8 days after surgery. These photos include bruising, inflammation and recently healed incisions that will all resolve through recovery

Dr. Ley’s results (she/her/they):

Keyhole Before and After_Dr Ley 1

Keyhole Before and After_Dr Ley 2

Keyhole Before and After_Dr Ley 3

Keyhole Before and After_Dr Ley 4

Dr. Facque’s results (he/him):

Keyhole Before and After_Dr Facque 1

Keyhole Before and After_Dr Facque 2

Dr. Jacobs’s results (he/him):

Keyhole Before and After_Dr Jacobs 1

Keyhole Before and After_Dr Jacobs 2

Keyhole Before and After_Dr Jacobs 3

Keyhole Before and After_Dr Jacobs 4

Dr. Mosser’s results (he/him):

Keyhole Before and After_Dr Mosser 1

Keyhole Before and After_Dr Mosser 2

Keyhole Before and After_Dr Mosser 3

Keyhole Before and After_Dr Mosser 4

Before Keyhole Top Surgery and Preoperative Instructions

At the Gender Confirmation Center (GCC), the primary candidacy requirement for a keyhole procedure is that patients have minimal chest tissue and a relatively high level of skin elasticity. Our practice does not have body mass index (BMI) cutoff nor do we require hormone replacement therapy (HRT) for patients who are considering top surgery. We encourage our patients to be at your healthiest prior to any surgery. Maintaining a balanced diet and engaging in regular exercise can help reduce your likelihood of complications.

We ask our patients to stop using certain medications, supplements and psychoactive recreational drugs before surgery to prevent negative impacts to healing. For this reason, it is important that you disclose which medications, supplements and recreational drugs you use during your surgical consultation. That way, we can discuss which medications and/or substances will need to be halted for you to undergo surgery. For more information on these requirements, click here.

For all patients, nicotine is especially important to stop before surgery, and we will discuss other drug use as well.  All nicotine use must be discontinued 3 weeks before and 3 weeks after top surgery.

While different surgeons have different policies about the use of medical marijuana, we ask our patients to switch to edibles for the 3 weeks before and after surgery to eliminate any smoking during this time.

Additionally, patients should not consume alcohol at least one week before and after top surgery.

Evaluation Process: Surgical Candidacy

While keyhole top surgery offers several benefits, not everyone is a good candidate for the procedure. The following factors are typically considered when determining eligibility:

• Skin elasticity and breast size: Patients with smaller breast/chest tissue and good skin elasticity are ideal candidates for keyhole top surgery. By skin elasticity, we mean that the skin hugs tight to the breast tissue.
• Overall health: Ideally, patients should be in good overall health and have a stable body weight to minimize risks and ensure optimal healing. At the GCC, we do not impose BMI restrictions onto patients for top surgery. We expect patients to disclose their medical history to our medical team during or prior to their consultation. Ideally, patients should quit tobacco use and be closely monitoring and caring for any medical conditions prior to surgery.
• Realistic expectations: Understanding the limitations of keyhole top surgery and having realistic expectations about the potential results is crucial. Bringing pictures to your surgical consultation that resemble what you would like your chest to look like post-op can help you and your surgeon reach a shared understanding of what can be reasonably achieved.

After Keyhole Top Surgery: Recovery Timeline

The keyhole top surgery technique is one of the few procedures that leaves the possibility for patients to maintain a high level of sensitivity in their nipples after surgery. Still, right after surgery, patients experience significant numbness in the chest. Sensation will return slowly over the first few months after surgery.

Keyhole top surgery tends to be one of the quickest procedures to recover from. Generally speaking, healing conforms to the following timeline:

• Week 1: During this time, patients will manage their pain with prescription and/or over-the-counter pain medications. You will not be able to operate a vehicle while taking prescription pain medications.
• Week 2-3: Patients will continue to use compression garments to manage swelling. Dressings over the incisions should be changed daily; Instructions will be provided at your first post-op appointment. Patients can begin to engage in light activities, though lifting over 5 lbs and strenuous exercise should be avoided.
• Week 4-6: Normal household activities can be resumed around this time, though patients should avoid lifting anything over 25 lbs until at least 6 weeks after surgery. Bruising and swelling should revolve around this time, and nipple sensation may begin to return.
• 3-6 months: Patients can begin to see their final results as swelling subsides and incisions heal into scars.