The hospital is indeed there, I didn't check the game thoroughly, However, there is still no option to enlarge the breasts, because in my opinion, even the ones with the number 3 are too small in the game... It would be nice if the male character had a penis, because mine doesn't have one unfortunately and it's a bit weird, I'm also waiting for the trans gender to be added (mostly shemales) because the male character has a pussy in this game I don't know why....
I wonder if you played the game to the point where the background is explained. Or if you did, if you really paid attention when Dr. Tucker explained the purpose of the character.
The picture you included above is from when you skip the prologue. I hope you played the prologue at least once. The "Male start" doesn't mean you play a male. It only means you were a male before the accident and before you got your new, female, body.
According to the story, this body was never meant to be male and was in fact prepared for another candidate who, without being explained in more detail, failed to occupy it. And so you were accidentally put inside, no matter if you have been a male or female before. Your previous body being male or female only means your starting properties and perks are slightly different.
Of course I'm not the developer so I'm not able to speak for them but from the explanations in the story and some comments I believe to have read in the past, the main character is meant to be 100% female. She is meant to be kind of a modern Mata Hari who was 100% female as well. So I doubt there will ever be a futa version. This simply isn't this kind of game and from what I've seen in the game until now, it simply wouldn't match with the game's background. You are meant to be a vulnerable woman who is meant to receive and not to give. But of course this is just my opinion and understanding. I may be completely wrong. Only Sam_Tail could tell.
And from the technical point of view, if you consider that all the graphics are painted by hand and each additional physical form would mean re-generating all the body parts and clothes for each of the new forms, I doubt Sam_Tail is willing to go this way. But here, too, of course I know nothing and who knows. Perhaps if you are a very generous Patreon supporter they might consider your wishes :)
"This doesn't make any sense, why did the dev do it like this???"
".... did you skip the unavoidable main story bit where it explains it?"
"Yeah, can't be arsed to read it."
"That would be why it doesn't make sense, then."
It amazes me how often I see this on comment sections for Visual Novels, despite "reading" literally being in the genre description.
Not to disagree with you, I completely see it like this, too, in general.
Although one might argue that "The Fixer", although written in RenPy, isn't your typical visual novel and, while containing a lot of important information in text form, might lead people to believe it is mainly a visual only game.
Of course people who play "The Fixer" without following the full descriptions and the story written in text form miss half of the fun of this great game. It's our "duty" to point this out to them. ;)