This patient is a 23 year old gender-queer genotypic female who presently uses feminine pronouns, plans to live more as a male, and anticipates possible testosterone therapy in the future. She does not want breasts, however, and came to Minneapolis Plastic Surgery for periareolar (keyhole) mastectomies. Her small breast size, lack of skin droop, and small areolas make her a good candidate for this procedure. She does not wish nipple reduction (wants to keep nipple piercings). Subcutaneous mastectomies were performed via a tiny periareolar incision on each breast; drains were removed in 1 week.