Subcutaneous mastectomy for female-to-male (FtM) gender affirmation is usually the first surgical procedure in gender reassignment. The main objective of subcutaneous mastectomy is to create an aesthetically pleasing male chest contour by removing all glandular tissue while minimizing chest wall scars. Moreover, reconstruction of the nipple-areolar complex (NAC) by the proper positioning of the NAC and an adequate reduction of the nipple and/or areola can be achieved, resulting in an aesthetically pleasing male chest reconstruction. Since the structure of the male breast differs from that of the female breast, not only in volume and projection but also in the size and position of the NAC, subcutaneous mastectomy cases must be evaluated preoperatively for choosing the appropriate surgical technique. To date, various mastectomy procedures in FtM gender reassignment procedures have been reported, including transareolar, semicircular, concentric circular, extended concentric circular and nipple-areolar graft techniques.