Somewhere in between, and it depends on the surgeon. Brassard will take limited specific requests - larger clit, smaller labia, that sort of thing - but probably won't produce an exact mimic of a porn star the way you can bring in a photo of a movie star to your hairdresser and get that exact hairstyle. 🙂
And it also depends, of course, on what material you have to work with. Some people are more... generously outfitted pre-op than others.