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Chin et al. Plast Aesthet Res 2023;10:52 https://dx.doi.org/10.20517/2347-9264.2023.44 Page 5 of 14

Figure 1. Diagram of the literature review process.

saying, “I think it is comparable to giving birth…the body is a completely different universe until it is
[18]
healed .” Given that embodiment describes the sense of one’s body, the process of embodiment post-
reconstruction is a process of acceptance of a new, altered body. Embodiment post-reconstruction can
include a redefinition of self in the context of the altered body and abandoning self-objectification of the
body [19-21] . In patients’ descriptions of seeking and undergoing reconstruction, they linked the physical
reconstruction to the process of striving to redefine the self, amongst their cancer diagnoses [18,20] .

These studies offer a starting point for outlining a framework for breast embodiment. However, there is
more extensive literature on measurements of prosthetic limb embodiment compared to breast
embodiment [13,14,22] . While breast reconstruction, autologous or implant-based, is not universally described
as a “prosthesis”, the prosthetic embodiment framework can be extended to breast reconstruction to
describe how effectively the reconstructed breast replaces a patient’s missing breast. There are parallels
between these contexts, insofar as alloplastic implants are analogous to prostheses, while autologous breast
reconstruction represents a reconstructive approach similar to limb salvage with bone allograft or
vascularized composite allotransplantation of the limb. In both contexts, “prosthesis” and reconstructive
approaches are intended to restore the normal form and functions of the missing body part. Therefore, we
sought to merge the themes from this literature review with established embodiment conceptions outlined
in the prosthetics literature to suggest a framework of “breast embodiment”.

PRIMARY DRIVERS OF EMBODIMENT
Within existing frameworks of prosthetic embodiment, two primary drivers of embodiment are ownership
and agency [13,14,22] . The proposed outline for understanding breast embodiment overlaps considerably with
prosthetic embodiment. However, there are a few key distinctions given their anatomic and functional
differences. We propose that “ownership” and “body representation” are the two main drivers of breast
embodiment, both of which are influenced by three domains of embodiment: sensation, posture, and
psychosocial [Figure 2].

Ownership is the sense that an implant or prosthetic belongs to oneself, or is “part of my body” or “part of
me [14,23,24] .” Ownership includes explicit and implicit subcomponents. Explicit ownership describes a patient's
conscious sense of the implant/prosthesis as instinctively part of their own body. A decreased sense of