This 36 year old gentleman has been living as a male for nearly 2 decades, has been on testosterone for 11 years, and came to Minneapolis Plastic Surgery for “top surgery” mastectomies and chest masculinization. He is 5 feet 5 inches tall, weighs 185lbs., and quit smoking 5 years ago, which is a critical factor in getting nipple areola skin grafts to “take” and survive. Fortunately, his wife is a non-smoker, since even second-hand smoke can kill grafts! He underwent double incision (without a vertical scar) mastectomies, nipple and areola reductions with reconstruction in masculine position as full-thickness skin grafts, and wore an elastic vest for immobilization of his grafts, and his chest dry for 4 weeks to allow full graft take. His operation was performed in MPS’s on-site, nationally certified (AAAASF) surgical facility under TIVA (general) anesthesia. This type of anesthesia has far less post-op nausea and vomiting (2-3%) compared to hospital or surgicenter inhalation (gas) anesthesia (7-28%). His post-op photos at 6 months still show some scar pinkness that will fade over the next 6 months.