Keyhole Top Surgery Procedure

Keyhole top surgery is a common type of female to male (FTM) top surgery procedure for transmen and non-binary patients. It’s a gender-affirming procedure performed on patients seeking a more masculine physique in the chest region. 

How Does Keyhole Top Surgery Work?

A keyhole mastectomy is an outpatient surgical procedure that lasts approximately two to three hours. It’s a chest reconstruction technique that involves creating a tiny incision at the border of the areola. Through this small opening, the breast tissue is carefully taken out. 

Keyhole top surgery in some cases may preserve the patient’s natural nipple sensitivity because, unlike other top surgery operations, the nipple stalk and the areola are left untouched. Depending on your surgeon and your individual case, your nipples may or may not be resized during the operation. 

Aside from offering a higher chance of maintaining nerve sensation, another benefit of a keyhole mastectomy is that patients tend to heal faster and experience very minimal scarring. The surgical incision is barely visible and typically ranges half the length of the areola’s border, plus there is no grafting involved. 

On the other hand, a known disadvantage with keyhole top surgery is that the inframammary fold (IMF)—or the boundary between the chest and the breast—is not taken out. That is why this particular surgical procedure is not suitable for all types of patients. 

Who Is Best Suited for a Keyhole Mastectomy?

In keyhole top surgery procedure, no excess skin is surgically removed. For this reason, a keyhole mastectomy is only recommended for patients who:

  • Have naturally small breasts 
  • Have tight and elastic skin around the treatment area

An ideal candidate for keyhole mastectomy would be someone considered to be more flat-chested in the range of an A-B cup breast size.

How to Prepare for Your Keyhole Top Surgery

Proper preparation plays a pivotal role in achieving phenomenal results in any medical procedure, and getting a keyhole mastectomy is no exception. Here are some practical FTM pre-surgery tips, which are centred on boosting your body’s natural healing ability and minimizing potential risks of adverse reactions.

Stop smoking three to six weeks before your operation:

According to the World Health Organization (WHO), smokers have a higher risk of suffering from post-surgical complications, which includes infections and delayed wound healing, compared to non-smokers.

Eat a healthy and nutritious diet loaded with essential vitamins and minerals:

Make a balanced top surgery diet focused on consuming fruits and vegetables packed with zinc and vitamin C, which are both linked with healing and building a more robust immune system. 

Be open to your doctor if you are taking any type of drug:

Some medications and supplements can cause excessive bleeding and prevent clotting, which will delay wound healing.

Avoid consuming alcoholic beverages:

Doctors warn against drinking even a small amount of alcohol before your top surgery, as it can weaken the immune system and impede recovery.

Keyhole Top Surgery Post-Op Care & Recovery      

Every patient has a unique healing process. Some may recover faster than others. For the first 24 to 48 hours post-surgery, the effect of anesthesia will gradually start to wear off so it’s expected to feel a certain level of discomfort and soreness, especially around the surgical site. Your movement will be limited.

For a speedy and smooth-sailing recovery experience, here are some practical tips to follow:

  • It is highly recommended that you arrange for a friend, a family member, or a professional caregiver to stay within you during the first 24 to 48 hours after the operation. 
  • Sleep on your back for a week post-surgery to avoid putting excessive pressure on your wound that may cause bleeding or swelling. 
  • Refrain from lifting your arms above your head for the first few days after your keyhole top surgery, which pulls on the skin and heightens your risk of fluid accumulation.
  • It is possible to go back to office work a week post-surgery. However, be careful not to do any heavy lifting or vigorous physical activity that may strain the surgical site. Wait for your surgeon to give the go signal before resuming to your normal work out sessions. 

Medical Drains

There will be two post-surgical drains attached to the treatment site. Their primary purpose is to collect blood and excess fluids that can accumulate inside the incision after a keyhole top surgery. Drains help the wound heal faster. Without this proactive approach, there’s a chance of fluid buildup that can cause pain, swelling, and inflammation. Medical drains in FTM top surgery prevent the formation of air, which can give the unwanted chest volume.

Some patients find this limiting and a hassle to maintain because you have to wear the drains up to a week after your top surgery or when the fluid collected reaches below 20cc to 30cc. Check and empty their contents, at least twice, every day. Refrain from moving too much or doing unnecessary physical activity while recovering from top surgery to minimize fluid buildup. You will be required to wear the medical drains for several days. 

After six to seven days post-surgery, your surgeon will ask you to come back to the clinic for a post-operative appointment. He will remove the drains, dressings, and check on how your wound is healing in general. 

Chest Binder

You will be provided with a compression binder to wear for around one to six weeks. Aside from preventing fluid buildup, the chest binder will also help lessen the possibility of scarring, keep the skin together, and make the pain more manageable. 

Potential Complications & Risks

Similar to any medical procedure, there are some risks involved with a keyhole mastectomy and other types of FTM top surgery. During your initial consultation, your plastic surgeon will talk about this subject in detail and explain to you the strategies and precautions he can take to execute the procedure safely and effectively.

The most common keyhole top surgery side effects may include:

  • Fluid buildup
  • Infection

Wound infection, fluid buildup, and nausea and vomiting are some of the most common side effects after going through any surgical operation. On the other hand, adverse reactions specific to keyhole top surgery may include:

  • Distorted nipples
  • Decreased nipple sensation
  • Keloid or scarring

Contact Us Today for a Consultation

Dr. Hugh McLean offers expertise in the latest keyhole mastectomy techniques, with decades of FTM surgical experience behind him. Patients come from all over North America to use his services as Dr. McLean has a genuine understanding of how important this personal journey means for his patients. 

For more information on keyhole top surgery, please reach out to McLean Clinic today. A member of our staff will be more than happy to assist you.

Book a free consultation now!