"Simpsons" showrunner Matt Selman had actually wanted to feature a character like Sage for several years; his wife, actress Renee Ridgeley, is a breast cancer survivor. She originally had implants following her mastectomy, but had them removed when they began to affect her health. "We are always looking to reflect the world as the world changes for good and for bad — usually bad! — but we didn't want it to feel preachy or jammed in," Selman recently told Yahoo! Life. "We wanted the fit to feel really clean." When the writers came up with a storyline in which Marge criticizes Lisa's body, Selman saw it as the perfect opportunity to introduce Sage.

Ridgeley is now an advocate for women who "stay flat" rather than undergo reconstruction. However, she says the character of Sage isn't meant to be a breast cancer symbol. "[T]he episode does not focus on her past disease," she told Yahoo! Life. "Sage shows up as exactly who she is now. By living openly as a one-breasted woman, she sends a message of acceptance and wholeness celebrated by individuals in marginalized groups."

Fans are raving about the episode. Reactions on the Instagram account include: "We love Sage! Thank you so much for this amazing representation," and "Beautiful representation of so many women out there."