This patient is a female to male transgender patient who contacted Dr. Medalie of Cleveland Plastic Surgery in Cleveland, Ohio in regards to FtM "top surgery". The patient desired a complete mastectomy with the goal of having a masculine chest that appeared as if he were genetically male. The various types of operations were explained to him and it was decided to proceed with a peri-areolar approach (keyhole approach) to the surgery. The patient had very good skin tone with good elasticity and Dr. Medalie felt that only a partial incision at the skin-areolar junction would be necessary. The surgery was performed as an outpatient at MetroHealth medical center, and the patient is shown five months after the procedure with excellent contour and minimal visibility of the scars. He was very happy with his "top surgery" and subsequent gender change.