This 42 year-old F to M transgender patient came to Minneapolis Plastic Surgery for total mastectomies (skin-reducing), nipple/areola reductions, and reconstruction in a masculine form (“top surgery”). The proper incisions are not the same as those used for a female breast reduction or cancer mastectomy, nor do nipples remain overly large or centrally placed on the chest as they do in a female. Rather, the nipples and areolae are reduced to masculine size (about 2.2 cm), and placed on the chest in proper position (lower and more lateral near the edge of the pectoralis major muscle). The scars will fade over 6-12 months. Small skin irregularities in the incisions settle as healing progresses, or can be revised under local anesthesia if needed.