It's real
But like you I'm not sure about the breasts. I'd say the scrotum is filled with saline...see the tubing. But saline is heavy and it would be hanging really low. So I'm more inclined to say it's filled with air or other gas.
Just a thought, maybe the person was castrated and the scrotum shrank enough that there wasn't enough skin for SRS, this might be a way of stretching the skin.
Then again I might be overthinking the whole thing!
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