There is a lot of different answers to these questions, I’ll give you the jist, then my specific answer.

Where does the breast tissue come from?

There is two main ways to do reconstruction - the most comment is breast implant. In this case they remove all of the breast tissue and leave just the skin. The remaining space is filled with a implant and the size of the implant is determined by how much skin you have. The second way it can be done is to transplant tissue from another part of your body to the breast area, it is usually from either the belly area (DEIP Flap) or from the back area (TRAM Flap). This type of surgery requires the surgery match up the tissue transplant on a vascular level (vein by vein) to make sure the transplanted tissue does not die.

I had a DEIP flap reconstruction - it requires almost a week hospital stay due to how complex the surgery is and recovery is 6-8 weeks, but honestly its been just about a two years and I am still recovering and also I have an additional revision surgery that I still need because - no I am not even close to being even.

How does one sculpt a nipple?

They typically do not. Normally the nipple is removed entirely. In the reconstruction I have heard of the nipple being rebuild but, its not nipple tissue, so its not the right color and it cannot react to environmental stimuli and from what I’ve seen, gets stuck sort of “hard”. When the nipple is removed most people will opt for a tattoo replacement. They look very very real and you don’t have the issue permanently smuggling raisins around. I was able to keep my nipple, visually it looks like a nipple, but I can no longer feel it.

Are they as sensitive as before?

No they lose all sensation, can’t even feel the skin, so not even like elbow skin, totally numb. They had to rebuild my stomach and belly button, so I also cannot feel anything across my lower abdomen either.

Does having breast cancer on one side automatically increase the chances of cancer on the other side? I would think symmetry isn’t a given?

No, the risk of recurrence is the same. If I was to have the same type of cancer in my other breast it would be a recurrence, not new cancer and after treatment my risk of recurrence is lower than my chance of getting a totally new type of cancer.

Were you able or allowed to choose size and shape? (If so, did you go for the tried and true original?)

Short answer no, long answer I was not very well endowed to begin with and my reconstruction was limited by the amount of tissue I could use for transplanting. So, again no and also they aren’t both the same size anymore, the reconstructed one is quite a bit smaller and not really the right shape, which is what I am going back in for more surgery to fix. If you had way more breast tissue than I did, there is more options for reconstruction, but from the woman I have talked to, most people end up going smaller or staying the same. Going up larger brings in a lot of complication and can only happen if you get a implant reconstruction and not a transplant.

Hope you’re doing well today. Not a question, I just wanted to say (write) it. Live long and prosper.

Thanks I plan on it 🖖

Just want to also point out for readers that this entire comment is only about gender affirming care and has nothing to do with medically treating cancer, but because we are affirming my breasts for my gender as a cis woman, its just healthcare.