This 31 year-old F to M transgender patient has been on testosterone therapy for about two years, and came to Minneapolis Plastic Surgery for total mastectomies (“top surgery”) and reconstruction of the chest in as masculine fashion as possible. Since he had smaller breasts and areolas, with good skin tone, periareolar (keyhole) mastectomies and nipple reductions were performed. Subcutaneous mastectomies removed the glandular breast tissue, and liposuction was utilized to sculpt and smooth the surrounding tissues. The larger protruding nipples were reduced at the time of the keyhole mastectomies. The entire outpatient operation took just under 4 hours, and after an additional hour in our recovery room, his light general anesthetic (TIVA) techniques allowed comfortable, non-nauseated discharge home to his caregiver.