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.