Keyhole / Peri-Areolar Technique
Keyhole and peri-areolar techniques are effective methods of chest
reconstruction if you have small amounts of breast tissue.
Most FTM surgeons offer these techniques if you fit an A cup or small B cup, although some surgeons will offer the peri-areolar technique up to a AA cup or 120grams of tissue.
The two procedures are similar in that they are performed by removing breast tissue through an incision around the areola (the area of darker skin around the nipple), but they do differ slightly in other ways.
Retention of nipple sensation is a major advantage to these types of surgery as is the minimal, and mostly hidden, scarring disguised by the darker areola.
Chest reconstruction will usually be performed as a morning operation and lasts for around three to four hours.
You will then be taken to recovery and monitored as you come round from the general anaesthetic.
Most patients are discharged that afternoon although others require an overnight stay.
The surgeon will make a small incision along the bottom of your areola and remove breast tissue using a liposuction needle inserted into the incision.
Your nipple will be left attached to the body via a pedicle (stalk of tissue) in order to preserve sensation making it advantageous over the double incision technique.
After sufficient tissue has been removed the incision will be closed up without the need, in most cases, for the nipple to be resized or repositioned.
If, after your surgery, you are dissatisfied with the position of the nipple you may be able to have revision FTM surgery to move it higher or correct any asymmetry occurring as a result of surgery.
This technique involves your surgeon making an incision in a circle around the edge of the areola.
Breast tissue is then removed used a scalpel and liposuction to reduce the volume of the breast, taking care to leave the nipple attached to the body via a stalk of tissue (pedicle) to preserve nerve function.
A wider ring of skin may be removed in a circle around the areola and the skin is pulled toward the center of the opening and stitched to the edge of the areola.
This "drawstring" effect can allow for some slight repositioning of the nipple to achieve a more natural look whilst preserving sensation.
The areola may be trimmed to reduce its size in proportion to your new chest and excess skin on the chest may also be trimmed to keep the chest appearance taut.
In both the keyhole and peri-areola techniques there are no long incision lines for surgical drains to follow.
Instead, these are inserted through the areola incision and curved under the pectoral area to exit at the axilla (armpit) via two small incisions.
The surgical drains help to collect and remove excess blood/fluid that may otherwise build up under the skin during the initial healing process.
A small plastic bulb collects the fluid outside of the body and this needs to be emptied periodically by either yourself or your helper.
The surgical drain may need to be in place for a few days to weeks depending on how long fluid continues to accumulate.