Good question.

Nevertheless, I see this as quite normal in general, not just in BID. After a major operation, I believe it is part of the damage control process. Ideally, in BID, it should appear as if the limb had simply stopped growing. Of course, this is not the case after an amputation, and everyone should recognize that achieving a perfectly aesthetic result is not always possible. It is simply the nature of the situation, and a scar will inevitably remain.
Additionally, a poorly shaped stump can cause not only aesthetic concerns but also issues with the prosthetic socket’s fit, ultimately affecting the we arability of a prosthesis and causing additional pain. In the best-case scenario, the stump would appear as if it had naturally stopped growing and never fully formed—like a perfect dysmelia but without a scar. However, that is wishful thinking, as the limb did develop.

If the appearance of the surgical site bothers me too much or unnecessarily limits my ability to wear a prosthesis, then the issue should be addressed. I would opt for an additional operation to prevent unnecessary skin problems and avoidable pain. That’s why I would choose the most comprehensive solution from the start.I also don’t see your example as merely an aesthetic correction, like cosmetic surgery. Who wouldn’t want to go out in shorts and a T-shirt on warm days without feeling self-conscious because it looks unusual and inevitably attracts extra attention at the beach or pool? Feeling watched is already an uncomfortable sensation, and unfortunately, an amputation naturally draws attention. Visually, one no longer conforms to the usual norm. A perfectly amputated limb that appears as if it had never grown, or as if nature had predetermined the separation point, seems somewhat utopian when aiming for a flawless result. Perhaps it is human nature to strive for perfection, or perhaps societal expectations have made it a necessity.

My wife was quickly stitched up after her accident with an electric fence or a ship rope. Years later, she underwent several plastic surgeries because she was frustrated by people staring at her whenever she wore a T-shirt, and it affected her psychologically. Of course, the results weren’t perfect, but they brought some improvement. 

In elective surgeries, a significantly better outcome can be expected compared to emergency procedures, even if it is not entirely flawless. From an aesthetic perspective, I consider this completely acceptable. Therefore, it should not be hastily equated with body dysmorphic disorder, even though it was unfortunately often perceived that way at first. 

This resonates with me on a very specific level. My BID need is a LAK amputation, 12cm above the former knee joint. My left leg even has four freckles (two on left and two on right) on my thigh that have always acted as a natural reference point. I've known this my entire life with a precision that still surprises me. And yes, the aesthetics matter enormously. Not in a vanity sense, but in the same way the location and level matter, it's just part of my internal map.

For me the ideal stump has always looked a certain way. A well-healed, rounded residual limb. Clean scar line. With proper myodesis, hopefully there won't be any puckering around the tip and scar, or floppy, sagging, non-reactive muscles. A stump that looks purposeful, useful, and complete. To me, this is beautiful.

But I want to add something that might differ from others here. I've never wished I had been born this way. If I had been, I probably wouldn't be on this forum now. I need to know the correction happened. The scar isn't something to minimize or wish away, for me at least, it's confirmation. Proof of the struggle and the journey. The scar at the end of my stump is visible evidence that the body finally matches the person inside. I need to see where the unwanted leg was removed. The scar is part of the resolution, not separate from it.

The surgical quality point is important beyond aesthetics too. A poorly formed residual limb would create real functional problems for me: socket fit, skin breakdown, chronic pain. For those of us hoping to live actively post-amputation, surgical technique isn't a cosmetic preference, it's foundational.

Knowing what outcome you want before surgery, and being able to articulate it clearly to a surgeon, seems critically important. The internal map most of us carry is actually an asset in that conversation if we're brave enough to use it. I've spent years scripting my plan. I just need the permit to proceed.

Beyond aesthetics, if I lost my right leg tomorrow I would probably be devastated, just like any other person after an unwanted amputation. If I happened to lose both legs and ended up a bilateral DAK, I would be fine — I would even be happy with the outcome. If I had an LBK amputation, I suppose it's closer to LAK, but still not right. I would still feel incomplete. And if I had an LHD amputation, I personally think it would push me into a very dark, depressive state. How can any of this make sense? But it just does, at least to me. And I know you all understand that as well.

I'm just so fascinated by how similar we all are, yet also so different. There's really no right or wrong answer to how each of us sees ourselves. And we all deserve to live our truth.

Interesting topic the aesthetic dimension.

My take, I see the body as something that develops as a whole over time. A body forming naturally has its own internal balance and proportion. One could mention ideas such as the golden ratio here, although I do not mean that a body is beautiful only when it follows some mathematical rule. My point is more that the body develops holistically, through both nature and nurture, all shape the individual phisical body as a whole.

I am saying this from a cultural and philosophical perspective, not from a biological one. I do not want to intrude into areas where I lack proper expertise.

Once the body is altered through voluntary surgery, cosmetic intervention, reconstruction, or anything similar, there is a human intervention into something that originally developed as an integrated whole. The body was not originally planned around that later alteration.

This may also explain why some people in cosmetic or plastic surgery more generally, start with one procedure and then feel drawn towards further corrections. Once one element is changed, the person may begin to notice other parts differently. The focus shifts from the whole to the detail, and then the next detail appears out of alignment. A process of realignment begins, and it may never feel fully complete.

So indeed aesthetics do matter as part of how the body is experienced.

As far as BID goes, most people have some idea of what their bodies' needs are.  They generally stop wanting more once they achieve what they need, though I am seeing some people wanting more afterward.  This is more the exception than the rule. 

My post, as far as aesthetics here goes, was more related to how one's limb would look if they got what they needed.  For them, they may want to have a nice, rounded stump, let's say.  They would want the limb they always wanted amputated and not the other one.  They would want the proper length.  Some who achieved their need may say that their stump is a few cm too long.  That is all aesthetics as I see it.  They are still happy to have gotten a stump on the proper side in any case.