An extremely bitter aftertaste remains, because the course of the pro- Bitter aftertaste ceedings and the openly demonstrated stereotypical patterns of justification – despite the many contrary avowals that have been proclaimed – make it clear in this exemplary case how difficult it is for women, even in a (divested) Civil Service unit, to attain a leadership position. It requires great power of endurance to be in a still valid employment relationship and to have to fight for a claim for damages against the employer in a legal dispute that continues for years. Individual case: VA-BD-SV/1018-A/1/2011 Breast augmentation operations for transgender persons Breast augmentation operations for transgender women can be medically indicated. In such cases, this should be covered by the Public Regional Health Insurance Offices. Two transsexual complainants contacted the AOB because the Vienna Public Regional Health Insurance Office had rejected an assumption of costs for breast augmentation operations several times. In both cases, there were expert opinions that attested that underdeveloped breast growth could no longer be expected to change under the influence of hormone treatments and that this caused massive psychological problems. The Vienna Public Regional Health Insurance Office took the point of view that such operations basically fall into the area of cosmetic surgery and the situation is comparable to genetic women who have small breasts. The AOB could not comprehend this approach to the subject nor the Medically indicated across-the-board exclusion of benefits. Rather, it had the opinion that a claim to a medically indicated anatomical approximation had already been considered as guaranteed due to previous decisions. After having had sex reassignment surgery, both complainants had undergone hormone therapy. As it was nevertheless impossible to achieve approximate gender alignment, existing alternatives to unsuccessful treatments were necessary. This was particularly the case if not performing this surgery was harmful to their health. 73