A certain amount of transparency in the ruse, a disjunction between what is being said (The breasts are real, I’m beset with a burdensome medical condition) and what is observed or otherwise learned (He’s strategically donning and doffing them, and appears otherwise strong and healthy, enough so to live life to it’s skydiving fullest), is an apex gaslighting technique designed to twist the knife via cognitive dissonance, and thereby increase to the maximum degree possible the pain, discomfort your target is experiencing.