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Chin et al. Plast Aesthet Res 2023;10:52 https://dx.doi.org/10.20517/2347-9264.2023.44 Page 7 of 14

THE THREE EMBODIMENT DOMAINS
The established domains that shape and create the drivers of prosthetic embodiment are motor, sensory,
[22]
postural, and psychosocial . These domains are integral to breast embodiment, with the exception of the
motor domain. Embodiment outcome measures typically assess one of these three domains-sensation,
posture, or psychosocial. In embodiment research, these domains are the interface for assessing how an
intervention can alter a patient’s embodiment level, given that these domains act as a gateway to influence
the higher drivers of embodiment.

The sensory domain encompasses the visual, tactile, vibratory, and temperature inputs that allow a patient
to receive feedback from the implant/prosthesis [31-33] . The postural domain describes the proprioceptive
features of an implant/prosthesis and the positioning a patient develops following reconstruction. The
psychosocial domain includes the self-image and social integration of an implant/prosthesis into a patient's
life. A key difference in breast embodiment compared to prostheses is the emphasis on sexual well-being
within the psychosocial domain. Sexuality is more commonly addressed in breast embodiment, which may
be attributed to societal roles in gender identity and breast sensation as it relates to sexual function, which
underscores the overlapping nature of the embodiment domains. Thus, the proposed framework of breast
embodiment offers a conceptual schema, rather than a rigid outline [Figure 2]. While sensation and motor
domains of embodiment are the most prevalent domains discussed within the current literature on limb
prosthetics, the psychosocial domain (including sexual function) is underrepresented [22,34] . Conversely, many
breast reconstruction outcomes focus on the psychosocial domain, with more recent increasing attention to
the sensation domain given advances in neurotization during breast reconstruction [35-37] . We identified the
relevant domains for each article included in our literature review on embodiment and breast
reconstruction [Table 1]. All included articles assessed psychosocial dimensions, while one-third included
sensation, and two articles included impacts on posture [Figure 3].

Sensation
The complete or partial desensitization of the chest following mastectomy and breast reconstruction is a
common phenomenon and contributing factor to altered embodiment [38,39] . Altered embodiment refers to
the disruption of one’s sense of self, or the experience of self-alienation from one’s body . However,
[25]
expectations for loss of breast sensation after mastectomy may not be clearly set for patients during their
course of care, which can lead to distressing outcomes [38,40] . Sensation was often tied to influencing
ownership and, in turn, embodiment. One patient described, “It seems as though [the breast] was not yours,
because, first of all, you have no sensations anymore ”.
[41]

Furthermore, a few articles highlighted the impact of altered sensations on intimate relationships [38,42] . In
response to numbness of the breasts following mastectomy, some women report aversion towards sex or a
feeling of frustration or detachment during sexual interactions [38,42] . Lindau et al. proposed leveraging
technology utilized in restoring sensation in bionic hands to restore sensation to the nipple-areolar
complex . They posit that providing sensation to the reconstructed breast fosters its embodiment and may
[38]
[38]
reduce post-mastectomy sexual dysfunction . Additionally, these relational impacts of altered sensation
extend beyond intimate partners. In one study, patients discussed the fear of modified touch and sensations
before undergoing mastectomy; however, they reported that modification of sensitivity and sensuality was
seldom discussed in medical contexts . This literature on the sense of touch in relational contexts, such as
[41]
hugging one’s child or partner, highlights how sensation is a crucial domain of breast embodiment.

Posture
Postural changes following breast reconstruction also impact embodiment. Particularly for patients