"Living with Hef brought down my self-esteem a lot," Madison confessed.
In an interview with Life & Style first obtained by PopEater, the buxom blonde said she agonized over her looks when she lived at the storied California mansion where a parade of stunning cookie-cutter centerfolds would come and go as they pleased.
"I was comparing myself to the other girls. ... You have to look a certain way at the mansion," Madison told the magazine. "If you look at Hef's girlfriend now, she basically looks like a clone of me. It's kind of weird."
The ex-"Girl Next Door" dished on her insecurities and said growing up, she always aspired to be like the women she saw in the glossy magazine.
"I compared myself to those [Playboy playmates]. I knew what I wanted to look like and was kind of disappointed," she said. "I had a butt and no boobs."
Holly, who split from Hugh Hefner last October, said she's happy with the plastic surgery she's gotten so far.
"Plastic surgery made it easier for me to get things I wanted in my career," she said. "Without it, I wouldn't be where I am today. ... My nose photographed really big in front of my face. If I wanted to do anything in the entertainment industry, I needed to get it fixed," she said.
"I was definitely happy with the results. It made me more confident. And a lot of doors open when you look a certain way."