Periareolar Mastectomy

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Periareolar (Keyhole) Mastectomy is a gender-affirming chest surgery that creates a flatter, masculine chest using a minimal-scar approach. It’s ideal for patients with a smaller chest and tight skin. 

Dr. Paul Steinwald, a double board-certified plastic surgeon, brings over 20 years of experience to his work with transmasc and non-binary patients. Known for his precision and warmth, he has refined his technique to prioritize sensation, safety, and aesthetics.

What Is Periareolar (Keyhole) Mastectomy?

This procedure, also called keyhole top surgery or circumareolar mastectomy, uses a circular incision around the areola to remove glandular breast tissue. Unlike double incision techniques, it leaves the nipple connected to the underlying tissue, which supports healing and sensory outcomes. 

The approach avoids large visible scars and eliminates the need for nipple grafts. Keyhole mastectomy is best suited to individuals with limited breast volume and no significant skin excess.

Who Is a Good Candidate?

Candidacy depends primarily on chest size, skin quality, and personal goals. Key traits include:

  • A or small B cup chest size
  • Tight, elastic skin that can retract post-surgery
  • No significant drooping or sagging
  • Stable general health and realistic expectations

Dr. Steinwald also welcomes non-binary patients whose goals align with a flat-chest outcome and who prefer a less invasive procedure. For more information, check out our candidacy guide.

What to Expect Before, During & After Surgery

Consultation & Pre-Op Prep:

Your journey begins with a detailed in-person or virtual consultation. Dr. Steinwald will assess your physical traits, review your medical history, and discuss aesthetic preferences. You’ll receive specific instructions on adjusting medications, quitting nicotine (if applicable), and planning for recovery support.

Before and After Photos

View our gallery to see patient outcomes from double incision chest surgery.

Before front view

Before

After front view

After

Before side view

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After side view

After

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The Surgical Process:

Performed under general anesthesia at our private Apex Surgical Facility, keyhole mastectomy typically takes one to two hours. Dr. Steinwald makes a curved incision along the edge of the areola. Through this access point, breast tissue is carefully removed. Minor liposuction may also be performed. Sometimes, the areola can be reduced in size, but nipple grafting is not part of this technique.

Recovery & Follow-Up:

Patients go home the same day. A compression vest is worn for chest support and swelling control. Most return to desk work or school in 7–10 days. Light activity is fine within the first week; exercise resumes around four to six weeks. You’ll have multiple follow-up visits, and Dr. Steinwald remains accessible to address post-op concerns.

Benefits of Keyhole Top Surgery

The periareolar method stands out for patients seeking subtle, effective results with fewer surgical trade-offs. Key benefits include:

  • Virtually hidden scars thanks to incisions placed at the areolar border
  • Preserved nipple sensation in most cases, since nerves aren’t severed
  • Less invasive than other top surgeries, with no skin grafts required
  • Faster healing timeline, which appeals to active patients or those with limited downtime
  • Masculine chest contour that looks natural without drastic incisions

This technique provides both physical and emotional relief for patients seeking chest masculinization with low visibility of surgical markers.

Cost and Financing

Pricing varies depending on anatomy and surgical plan, but a full estimate is provided at consultation. 

Our office works with financing programs such as CareCredit, and we’re happy to help with insurance documentation. Many patients use a combination of private pay and insurance support for gender-affirming chest surgery.

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Why Choose Dr. Steinwald

Dr. Paul Steinwald has been performing gender-affirming chest surgeries since 2002. His training at UCSF and Dartmouth and years of hands-on refinement make him a leading expert in keyhole top surgery. 

Patients trust him not only for technical results but for his human approach, listening closely, respecting identity, and offering ongoing access post-surgery. Every procedure is performed at a private, accredited surgical center, where safety and discretion come first. 

Special accommodations for fly-in patients seeking FTM top surgery may also be available. 

FAQs About Periareolar Mastectomy

Eligibility is based on chest size, skin elasticity, and overall health. A consultation with a surgeon is necessary to determine whether your anatomy fits the requirements. Typically, individuals with an A or small B cup and firm skin are good candidates.
Yes. The nipples are usually left attached to preserve blood supply and nerve connections. This helps improve the chance of maintaining natural sensation and nipple projection after healing.
Yes, most surgeons require patients to wear a compression vest for 2–4 weeks after surgery. This helps reduce swelling, support the chest, and promote smooth contouring during healing.
Yes. Hormone therapy is not a requirement for surgery. Many transmasc and non-binary individuals pursue top surgery without being on testosterone.
Scars typically blend into the edge of the areola and are difficult to see once healed. However, scar visibility varies depending on skin tone, healing response, and post-op care.
Some surgeons place drains to prevent fluid buildup, but others may use surgical techniques that avoid them. Drains are usually removed within a few days to one week after surgery.
Moderate weight changes generally won’t impact results, but significant weight gain may increase fat in the chest area. Likewise, weight loss could alter skin tightness and contour.
It’s possible, depending on your health and surgical goals. Some patients pair top surgery with minor liposuction or revisions, but combining multiple surgeries requires careful planning with your surgeon.

Book Your Keyhole Top Surgery Consultation in Denver

If you’re ready to move forward with gender-affirming chest surgery, Dr. Paul Steinwald offers the experience, honesty, and care you deserve. Schedule a private consultation to ask questions, explore your options, and find out if periareolar top surgery is the right fit for you.