Male-to-female patients undergo further nipple enlargement after breast augmentation to achieve an appearance similar to that of female breasts. Because congenital male nipples are mostly small with tight skin, an increase in nipple length or volume is limited by physical conditions, so the nipple area can only be expanded by two times in maximum. Two surgical procedures are optional. One is areolar skin transfer to enlarge the nipple. Three to four wedge-shaped flaps will first be designed at the areolar skin at the bottom of the nipple, and they are then transferred to the bottom or side of the nipple to prop up the nipple height or increase the nipple volume. The advantages are the simplicity of the procedure and low risks and the fact that the sense of touch remains the same as that of the original. The disadvantages are that the flap transfer is limited to some extent and is confined by the available areolar skin, so support to the nipple height or projection may be inadequate, and it may be difficult to achieve the large and projected nipple appearance similar to that of the female nipple. The second method is the emplacement of autologous auricular cartilage or costal cartilage to the nipple to enlarge the nipple volume and enhance support. The advantages are that the cartilage is relatively tough and less likely to be absorbed, thus able to effectively enlarge the nipple height and area; however, the disadvantages are that the cartilage from other body parts has to be harvested for transfer and that the original tightness of the nipple skin may squeeze the cartilage, thus leading to more self-absorption, which may undermine surgical results. If the patient does not want autologous cartilage nipple transfer, a heterologous rib can also be emplaced, which, however, presents a higher absorption rate and infection incidence than autologous cartilage and has to be validated for long-term effects at the nipple.