This 57 year-old patient came to Minneapolis Plastic Surgery for transgender total mastectomies as a long-considered (permanent and irreversible) first step in the female to male transgender process. The patient has been living as a male (clothing, name change, and binding breasts) for many years, and is not on testosterone therapy. Total mastectomies, nipple/areola reductions and reconstructions were performed as an outpatient operation that took about four hours. The patient returned to everyday activity (non-strenuous) in 1 day, and all bandages and compression garment were finished at 3 weeks. After photos are shown at 3 months post-op. Repigmentation of the areolar grafts can be expected over several more months (or color-match tattooing as with breast reconstruction patients can be performed). Smoking or incomplete graft “take” can cause pigmentation irregularities.