The “keyhole” terminology is often misused in the context of top surgery.
A keyhole surgery for classic cisfemale breast reduction involves a vertical incision under the nipple area, as shown in this photo:
Peri-areolar surgery, also known as the “donut” technique, is an incision only around the darker areolar skin. This can be done for someone with exceptionally small breasts and no extra loose breast skin.
Dr. MacPhee has performed the peri-areolar option for top surgery, with the patient having the same recovery time as the “double incision.” However, the visual result of the nipple/areola can be less appealing because it is more difficult to reshape and reposition the areolar/nipple complex with the peri-areolar method.
For transmale and non-binary patients, there are cases where we will preserve the main nerve to the nipple to enable sensation. In such cases, we perform a reduction of the tissue, not a total mastectomy.
The cost of surgery is the same for both procedures, and they have the same recovery timeline.
