But the thing is, it IS part of the game. You can run with that outfit. Her boobs will be enlarge throughout the game with jiggle affects everywhere. So let's take your example again:

Your female coworker is in a bikini and super mega foxy hot. You think differently of her.

She now got a boob job! You think differently of her. She is now walking around in her normal clothing but with huge tits!

So yeah these changes DO affect the character. And the changes aren't fanart. They are canon!