This 26 year old F to M transgender patient came to Minneapolis Plastic Surgery for skin-reducing top surgery (transgender total mastectomies with skin tailoring). He also required nipple and areola reduction and reconstruction as properly-placed (lateral and down masculine position rather than central feminine position) skin grafts. He also requested ultrasonic liposuction of the abdomen and hip rolls at the same operation. Outpatient surgery was performed in our AAAASF-accredited office surgical facility under a light general (TIVA) anesthetic, which allows rapid and comfortable emergence from anesthesia with minimal chance of nausea. After photos are shown 5 years post-op, though local anesthesia revisions of extra skin in the mastectomy scars and areolar grafts were done 7 weeks prior to the final result shown.