Keyhole Mastectomy and Nipple Reduction at the Same Time?

Thank you for the question.  I think you may be referring to a mastopexy procedure?

As plastic surgeons  one of our major concerns with the type of operation you are considering is blood flow and the survival of tissues that are manipulated during your procedure. If an incision is used around the areola and nipple surgery is done at the same time you may be at increased risk for blood flow “problems” to the involved tissues. Sometimes, it is better to do these procedures in a staged fashion. In my practice, every patient's care is individualized.

 I hope this helps.  You may also find the attached link instructive.

The solution to your specific breast shape is to undergo the breast removal and replacement of the nipple and areola as separate grafts ie. two grafts per breast. The nipple graft is placed in the center of the areola graft. Each graft is in contact with your healthy skin and will take completely. In this manner, all sizes of nipples and areolae can be customized to your preference.