This 22 year old female to male transgender patient has been living full-time as a male for nearly 3 years, and has been on testosterone for 2 years. He came to Minneapolis Plastic Surgery for top surgery because of our over 3 decades of transgender surgery experience, as well as referral from several friends who had surgery here. Skin-reducing mastectomies were performed in a 4-hour operation that did not use a female breast reduction (anchor) pattern, and with nipple/areola grafts of the right size and masculine position. Chest masculinization does not preserve any female breast tissue, and good scar placement simulates a lower pec crease, especially in a muscular patient such as this. After photos show appearance at 6 months post-op; scars will continue to fade over time.