The guy in the picture appears to have had (i) a "breast" implant (probably an "A" or "B" cup), and (ii) an areola tattoo (aka areola pigmentation). As to the former, I have heard that some men prefer more supple, rounded female breast implants than the more traditional hard silicone for men (notice the rounded breast tissue on the guy in the picture). I also understand that very few, if any, plastic surgeons in the US will do that, but it's easily done in many countries outside the US (e.g., Mexico, Thailand, Philippines, etc.). As to the latter, areola tattooing/areola pigmentation is becoming more popular here and abroad. An alternative observation is that the guy n the picture may have been a pre-operatve female-to-male transgender (notice the lack of muscularity in the upper torso, particularly the shoulder and bicep areas), and the bulge may have been a small dildo or something similar. Also notice the feminine features of the guy, especially the forehead.