This 19 year old F-M transgender patient came to Minneapolis Plastic Surgery for top surgery (chest masculinization). He has moderate sized breasts without well-defined inframammary creases, small nipple/areola complexes, and youthful skin elasticity that allowed keyhole mastectomies. Outpatient surgery under TIVA general anesthesia in our office surgery facility allowed a short recovery room stay, no nausea or vomiting, and return home with minimal discomfort. Short periareolar scars are virtually invisible, and no skin-reducing mastectomy incisions were needed. Post-op photos show his smooth chest at 7 months. Further refinement is possible with nipple reductions, which can be performed under local anesthesia.