Keyhole Top Surgery: Your Questions Answered

The keyhole method is a type of chest reconstruction top surgery that involves making a small incision along the border of the areola, through which the surgeon carefully removes the chest tissue. This procedure involves very minimal scarring since it creates a small scar up to half the length around the areola border. Since no excess skin is removed in this procedure, it is only available to patients with minimal chest tissue and relatively elastic chest skin. Thus, only about 5% of the population are good candidates for this type of surgery.

This article provides information on the procedure itself as well as risks and benefits of the keyhole method. We also cover the top surgery recovery process, scar appearance, nipple sensation, and procedure costs. Find out if you are a good candidate for this type of top surgery here.

How is a Keyhole Top Surgery Performed?

During a keyhole procedure, the surgeon first makes an incision alongside the areola, and cuts through the top of the chest tissue, leaving behind a uniform layer of thickness of fat beneath the skin that matches the thickness of the surrounding chest. The surgeon then removes the unwanted chest tissue. All chest tissue is sent off to a pathologist to screen for cancer, though finding any is extremely rare.

Once the chest tissue is removed, liposuction may be performed along the borders of the tissue excision to provide a smooth and uniform result. A surgical drain will be placed before closing the incision. The drain is usually in place for about seven days after surgery and is then removed.

Benefits of Keyhole Top Surgery

Keyhole top surgery offers several advantages over traditional top surgery techniques, making it an attractive option for many individuals seeking gender-affirming care.

• Minimal scarring: The incisions are confined to the lower half of the areola, resulting in less visible scarring. Patients are still recommended to follow scar care protocols, like keeping scars protected from UV sun rays for the first year post-op.
• Faster recovery: With smaller incisions and less tissue removed, the recovery process is typically quicker and less painful.
• Improved chest sensation: The minimally invasive nature of the procedure and preservation of the original nipple-areola complex allows for a greater probability that patients will retain the same amount of sensation on their chest post-op.
• Increased patient satisfaction: Some patients report higher levels of aesthetic satisfaction with the results of keyhole top surgery compared to a double incision top surgery.

Candidates for Keyhole Top Surgery

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:

• Breast size and skin elasticity: Individuals with smaller breast tissue and good skin elasticity, meaning that patients have skin that hugs tight to the breast tissue, are generally better candidates for keyhole top surgery.
• Overall health: 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.

Keyhole Top Surgery Recovery Process

Right after the procedure, patients may experience significant numbness in the chest. Sensation usually returns with time, often at the same level before surgery. In other words, this is one of the few chest reconstruction techniques that leaves the possibility of preserving a heightened, erotic nipple sensation post-op, much like the inverted T, buttonhole, and nipple-sparing double incision techniques.

The recovery process following keyhole top surgery is typically shorter and less intensive than traditional top surgery methods. Here’s what you can expect:

• Week 1: Patients can expect moderate bruising, swelling and discomfort. Pain will be managed with prescription and later over-the-counter pain medications. Surgical drains are in place and may be removed at the first post-op appointment.
• 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.

Cost and Considerations

The cost of keyhole top surgery can vary significantly depending on factors such as the geographic location, the surgeon’s experience, and the surgical facility. At the GCC, cash-pay patients who do not have insurance coverage might pay anywhere from $14,000-$17,000 for top surgery. For more information on top surgery costs, click here.

Insurance coverage can drastically reduce these costs. Many insurance plans, including Medicare, cover gender-affirming surgeries like keyhole top surgery. However, coverage and requirements vary by plan and state. It’s essential to check with your insurance provider for specific details on coverage, pre-authorization requirements, and any exclusions or limitations.

If insurance coverage is unavailable or insufficient, financing options such as medical loans or crowdfunding campaigns may be worth exploring. Additionally, some LGBTQ+ organizations and advocacy groups offer resources for financial assistance with gender-affirming care.

Choosing a Surgeon

Selecting a qualified and experienced surgeon is crucial for ensuring the best possible outcome and minimizing risks associated with keyhole top surgery. When choosing a surgeon, consider the following factors:

• Board certification in plastic surgery and/or training in gender-affirmation surgery
• Extensive experience performing keyhole top surgery specifically
• Positive patient reviews and before/after photo galleries
• Open communication and a commitment to understanding your goals
• Accredited surgical facility with appropriate safety measures

FAQs

Q: How visible are the scars after keyhole top surgery?

One of the primary benefits of keyhole top surgery is minimal scarring. The incisions are made around the areola, allowing the scars to be concealed and less noticeable. With proper scar management and time to heal, the scars will fade and become less prominent.

Q: Will I lose nipple sensation after keyhole top surgery?

It is common to experience some temporary loss or alteration of nipple sensation after keyhole top surgery. However, in most cases, sensation gradually returns as the nerves heal. The extent of sensation recovery can vary from person to person.

Q: Can I still breastfeed/’chestfeed’ after keyhole top surgery?

Keyhole top surgery involves the removal of breast tissue, including the milk ducts and glandular tissue responsible for milk production. Therefore, it may not be possible to chestfeed after undergoing this procedure.

Q: How long do the results of keyhole top surgery typically last?

The results of keyhole top surgery are generally considered permanent, barring significant weight fluctuations or other factors that could alter the chest contour. However, it is important to note that the skin and tissues will continue to age naturally, and some degree of sagging or changes in appearance may occur over time. Chest reconstruction top surgery will give you permanent results. However, significant fluctuations in your weight may impact the appearance of your chest. In most cases, you would need to gain a great deal of weight for the chest contour to change substantially.

Dr. Jacobs (he/him), one of our expert top surgeons, addresses the question of how significant weight fluctuation after top surgery might impact your results:

Q: Are there any risks or potential complications associated with keyhole top surgery?

Similar to any type of surgery, the potential risks and complications associated with keyhole top surgery can include bleeding, infection, poor wound healing, scarring, and adverse reactions to anesthesia. However, these risks are generally low especially when performed by a qualified and experienced surgeon. Your surgeon will discuss the specific risks and steps to minimize them during your consultation.

Q: What happens if I’m not a candidate for keyhole top surgery?

If you’re not a suitable candidate for keyhole top surgery, your surgeon may recommend alternative top surgery techniques, such as a periareolar incision or double incision with free nipple grafting. The appropriate procedure will be determined based on individual anatomy and surgical goals.