Wild-assed opinion only

And I don't think I can emphasize that enough as I have ZERO real-life experience on the subject (D3 Gold)....but there is no single answer. People's emotional situations cannot be boxed into a once-size fits all answer.

Personally, I tend to believe that cosmetics are a very minor part of the situation. I have heard of cases where people are highly offended and distressed by having the "wrong" junk for their mindset but I see that as a secondary issue. Just about everyone hates their body--some to extremes--and that issue should be first attempted to be addressed with methods other than an axe. There is more going on than just a parts issue.

Using using weight loss as an analogy--many think their life will be magically better if they only lose the weight. The problem is, when you lose the weight you are just as stupid as before, just as grouchy, just as nice, etc--you are still you with less weight. There is no magical "new you" simply from the change. Anything new comes from inside, not the outside stuff.

As with the general populace, AFTER the mental and emotional aspects have been addressed and it is clear that it is not a "wish I looked right" and extends to a "NEED to have my body match my perception", then yes, I think the state kicking in is warranted. If that point can be determined (D3 Gold), it is no different than the allowed surgeries to correct other physical malformations.