This 22 year old gentleman came to Minneapolis Plastic Surgery for top surgery, as he has been living full time as a male for 7 years, binding his breasts for 6 years, and on testosterone for 3 years. Like the majority of transmen on testosterone, he noted no significant reduction in breast size, and required nipple and areola reduction, skin-reducing (double-incision) total mastectomies, and reconstruction of his nipple/areola complexes in masculine size and position as full-thickness skin grafts. His outpatient surgery in our nationally-accredited (QUAD A) in-office on site surgical facility took 4 hours, and he left our recovery room one hour later without nausea or vomiting, largely because of our TIVA anesthesia. TIVA avoids all inhalation anesthetic gases (other than oxygen) and reduces post-operative nausea and vomiting substantially. Post-op photos show scarring that has faded considerably after 15 months.