A 15-year-old transgender child will have both of her breasts removed after the Family Court approved the surgery.

The decision is believed to be the first time the court has allowed such major surgery prior to a child beginning hormone treatment, The Australian reports.

The child has been dressing as a boy since the age of four but because she has not begun hormone treatment to suppress puberty had developed large E-cup breasts.

The court heard the child, referred to in court documents as Quinn, was in a great deal of psychological and physical pain because of her breasts and wanted them removed as soon as possible.

Quinn was hoping to begin hormone treatment within the next 12 months and the surgery was needed to avoid the child having breasts, a hairy chest and beard.

“Society has begun to accept transgender individuals, however I am highly doubtful they would accept an individual with a beard, hairy chest and an E-cup bust,” a psychologist, who cannot be named, told the court.

Under international guidelines, genital surgery should be avoided until children reach 18 to avoid a situation where they change their mind.