The patient has gender dysphoria. She has been living as a female for over 10 years. She has requested breast augmentation that the health plan has denied as not medically necessary. The health plan's determination is overturned. The breast augmentation is medically necessary. The patient meets the WPATH (World Professional Association for Transgender Health) "Standards of Care for the Health of Transsexual, Transgender and Gender-Nonconforming People" guidelines for the breast augmentation in Male to Female patients.