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Page 6 of 14 Chin et al. Plast Aesthet Res 2023;10:52 https://dx.doi.org/10.20517/2347-9264.2023.44

Figure 2. Breast embodiment framework.

ownership, or feeling of estrangement from one’s own body post-reconstruction, can lead to decreased
embodiment. One patient who underwent breast reconstruction noted, “At least there is something to fill in
[18]
the bra, so I guess people will never notice that the breast is not mine” (emphasis added) . In contrast,
implicit ownership represents a patient’s unconscious behaviors towards the implant/prosthesis. In the
context of breast prostheses or reconstruction, sometimes forgetfulness of the breast prosthesis can promote
a sense of ownership, insofar as if the person is constantly cognizant of the prosthesis, by feeling pain or
constantly feeling, these sensations may highlight the foreignness of the prosthesis . Thus, these
[25]
subconscious behaviors facilitate a sense of ownership.

While “ownership” applies to both prosthetic and breast embodiment, the driver of “agency” is less
pertinent to the context of breast reconstruction. In regards to prosthetic limbs, agency refers to a patient’s
[14]
capacity to start and terminate their actions to control their prosthesis in a deliberate manner , which is
outside the scope of breast embodiment given the lack of motor actions as a primary function. Instead of
agency, we suggest that body representation is a second key driver of breast embodiment. Previous literature
has included body representation as a major component of embodiment, alongside ownership and
agency [13,26,27] . The integration of a reconstructed breast into one’s body representation facilitates
embodiment, in so far as the foreign object or reconstructed tissue becomes part of the neural structures
[14]
that guide awareness and perception of the body .
Body representation encompasses the experiences, understandings, and knowledge of the physical structure
of one’s body [13,28] . Similar to ownership, there are explicit and implicit subcomponents of body
representation. Explicit body representation refers to conscious experiences of the body, which include its
shape, size, location, and physical properties. “Body image” is often defined as these explicit experiences of
“body representation [13,28,29] ”. Whereas implicit body representation is often referred to as “body schema ”.
[29]
Body schema refers to the body’s spatial properties, and the subconscious or unconscious mechanisms that
direct posture and movement. At this implicit level of body representation, an object becomes embodied if
its properties are cognitively processed similar to the properties of biological body parts . In the context of
[30]
breast reconstruction, the integration of a reconstructed breast into one’s body representation supports the
sense of embodiment.