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Page 2 of 14 Chin et al. Plast Aesthet Res 2023;10:52 https://dx.doi.org/10.20517/2347-9264.2023.44

INTRODUCTION
Advances in postmastectomy breast reconstruction techniques have led to increasingly nuanced methods of
[1-3]
assessing reconstructive outcomes . While historically breast cancer surgery centered solely on successful
resection of malignancy, rising survival rates of breast cancer patients have led to increased attention to
[4-6]
quality of life metrics following breast reconstruction . While alloplastic interventions have been the most
common form of reconstruction over the past twenty years, developments in tissue-based, autologous
approaches have led to the possibility of a softer, more natural-appearing breast mound and, in turn,
improved long-term patient satisfaction [7-10] .

In the context of breast reconstruction, the BREAST-Q is the current gold standard patient-reported
[11]
outcome measures (PROMs) instrument . The BREAST-Q measures physical, psychosocial, and sexual
well-being, in addition to patient satisfaction with breasts, outcome, and overall care. The BREAST-Q has
evolved considerably since its inception in 2004, notably with the recent addition of a sensation module .
[12]
However, as breast reconstruction techniques continue to evolve, investigating patient outcomes utilizing
research approaches from reconstruction and prosthetic replacement of other areas of the body may be
useful. Within the prosthetic limb literature, the advancement of neural interfaces that allow improved
control and sensory feedback from prostheses has spurred new outcome measures centered on dimensions
of embodiment [13-15] .

Embodiment describes the sense of one’s own body, or with respect to prostheses, how effectively the
[13]
prosthesis replaces a patient’s absent or altered body part . The primary domains of embodiment for
prosthetic limbs are motor, sensory, postural, and psychosocial domains. These domains shape a sense of
ownership and agency, which facilitate the embodiment of the prosthesis. Regarding breast reconstruction,
we suggest that embodiment encapsulates existing quality-of-life measures, including psychosocial well-
being, sexual well-being, and sensation, and expands on them to offer a more holistic and personal
framework for understanding one’s sense of self post-reconstruction.

Given the extensive literature on prosthetic embodiment, we propose its incorporation into discussions on
improving and evaluating breast reconstruction outcomes [13-15] . This systematic review aims to summarize
existing literature on breast reconstruction and embodiment, and discuss how embodiment can be a helpful
framework for the future of breast reconstruction outcome measures.

METHODS
This literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines . To review existing literature on breast reconstruction and embodiment, we queried
[16]
the PubMed/MEDLINE, Web of Science, Embase, and Cochrane databases with relevant search terms,
including combinations of “embodiment” and “breast reconstruction,” “breast implant,” or “breast”
[Figure 1]. Our search strategy included all articles published in the years 1977 to August 2023. Studies not
available in the English language were excluded.

RESULTS AND DISCUSSION
Breast embodiment framework
The literature search on embodiment in the context of breast cancer surgery yielded 320 articles, of which
21 were ultimately included [Figure 1]. The majority of these studies applying “embodiment” to assessments
of patients’ experiences following breast reconstruction utilized qualitative methodologies, predominantly
semi-structured patient interviews [Table 1]. Many of these patient interviews centered on the broad
research question of how women experience oncoplastic breast surgery, and then “embodiment” served as a