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Whatever you're talking about, I can't seem to find any information about it, but my guess is that they are deliberately misrepresenting medically recommended breast reduction and mastectomy surgeries as being gender affirming, when they may be related to early puberty or childhood cancer. (I know a woman who had significant breast reduction surgery at 11, and she is still very well endowed as an adult).
Having access to transphobic parents willing to use their own kids as a prop for hate, just because they have breast surgery scars that push an emotionally charged narrative, is probably just a numbers game in a place like Ohio...
I'll have to try to get a picture from the YouTube ad next time I see it. It doesn't seem real. It's two shirtless kids with giant line scars from armpit to armpit. I don't think there's any legitimate surgery that creates scars like that.