This 15 year old straight-A student 10th grader is a F to M transgender patient who has lived full time as a male for 2 years, has been on Testosterone for 6 months, and binds his large ptotic breasts. He was referred to Minneapolis Plastic Surgery by parents of other minor-age transgender patients in their support group who had had “top surgery” at MPS. With the approval and support of both parents, his psychologist, and endocrinologist, he underwent star-pattern nipple reduction, areola reduction, skin-reducing mastectomies, and nipple-areola reconstruction as full-thickness skin grafts in masculine size and position. TIVA anesthesia in our nationally-accredited (QUAD A) outpatient on-site office surgical facility allowed a rapid, no-nausea recovery (as compared to hospital inhalation (gas) anesthesia). His scars will continue to fade over the next 6-12 months.