This paper describes the indications for operation, the choice of operation, and the results in 9 patients evaluated by a gender identity clinic and referred for breast removal and construction of a male chest. These patients have lived for an average of ten years in their cross-gender identity and were found to be stable, nondemanding, cooperative, and responsible in their life as males. A different operation is recommended for each of three types of breasts. None of the patients was suitable for a simple gynecomastia-type operation. Patients with excess skin should have a procedure that produces an inframammary crease scar not connected to the nipple. Patients with less skin require a procedure that results in a C-shaped scar curving downward and laterally from the nipple.