The FTM/N Top Surgery Keyhole Method is a procedure for chest reconstruction that involves a small incision along the areolar border, through which the chest tissue is carefully removed by the surgeon. Despite its many benefits, only about 5% of the population are good candidates for this procedure because it requires that patients have minimal chest tissue and tight chest skin.
This procedure is desirable because it involves very minimal scarring. The procedure creates a small scar up to 1/2 the length around the areola border. There is no excess skin removed at all in this procedure, and therefore it is only available to patients with minimal chest tissue and relatively tight chest skin.
It is not certain as to the reason that it is called a Keyhole procedure, but it may be because the surgeon performs the entire chest excision through a very small incision and therefore they must look around beneath the incision, perhaps in a similar way to the days when people could look around an entire room through in old-fashioned door keyhole.
The surgeon first makes an incision alongside the areola and then dissects out across the most superficial surface of the chest tissue, leaving behind a uniform layer of thickness of fat beneath the skin that matches the thickness of the surrounding chest. Then the surgeon goes underneath the chest tissue and removes the chest material as a specimen. All chest tissue is sent off to a pathologist to check for cancer. It is extremely rare to find any cancer in this tissue.
Once the chest tissue is removed, the surgeon might perform final refining steps such as liposuction along the borders of the tissue excision to provide a smooth and uniform result.
Often, the surgeon places a drain and then closes the incision. The drain is usually in place for about seven days after surgery and is then removed.
After the procedure, the patient may experience significant numbness of the chest. Sensation usually returns with time, often ultimately feeling the same as before surgery.
With all of the benefits of the keyhole procedure, it is not surprising that the few individuals who have anatomy favorable for this procedure consider it strongly. Unfortunately, as stated above, less than 5% of patients are candidates for a keyhole surgery because of their very small amount of chest tissue.
This page begins with an animated video that shows how the keyhole incision procedure is done.