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

the breast area has affected the quality of life and to quantify the amount of sensation felt in the breast
[12]
during certain activities (i.e., when pressing, bumping something, showering, touched sexually, hugging) .
The concept of embodiment can offer additional dimensions to future iterations of outcome evaluations.
[15]
Newer tools such as the Prosthesis Embodiment Scale may serve as inspiration . The Prosthesis
Embodiment Scale includes thirteen items that correlate with measurements of embodiment, including
ownership [“The prosthesis is my (body part)”], belongingness (“The prosthesis belongs to me”), affiliation
(“The prosthesis is part of my body”), and completeness (“My body feels complete”). Other items such as
integrity, self-observation, posture, touch, and vividness are also relevant to breast reconstruction outcome
measures and could serve to enhance existing BREAST-Q metrics.

This literature search was predominantly comprised of qualitative patient interviews. The BREAST-Q and
other patient-reported outcome measure tools are also developed through in-depth qualitative interviews
before quantitative field testing. We suggest that embodiment may be a helpful concept for widening and
diversifying the scope of conversation during such interviews. Furthermore, it is essential to recognize the
limitations inherent to questionnaires and other quantitative measurement tools. These tools are often
confined to discrete information about aspects of one’s body at a specific moment and, therefore, can be
limited in accounting for the diverse multitude of bodily experiences . There is growing recognition of the
[25]
role of qualitative research in the field of plastic and reconstructive surgery [68-70] . Given the complexity of
breast embodiment as a conceptual framework, we suspect qualitative data will continue to play an integral
role in eliciting these patient perspectives.

Limitations
There were limitations to this review. Since the concept of embodiment has been sparsely discussed within
existing surgical literature, this systematic review utilized a wide inclusion criterion, including articles from
outside the field of plastic surgery, primarily psychology and qualitative health journals. Given our aim to
introduce the concept of breast embodiment more broadly, this review included literature describing patient
experiences with multiple forms of breast reconstruction. We did not elucidate differences in embodiment
between the different types of mastectomies (i.e., total, skin-sparing, nipple-sparing, etc.) and different
forms of reconstruction (i.e., autologous, alloplastic). It is likely that there are embodiment differences
between autologous and alloplastic reconstruction, and thus future work analyzing breast embodiment and
measurements of its domains within these two different contexts is warranted.

While we mainly focused on breast embodiment in the context of reconstructive surgery, it is worth noting
that using an external breast prosthesis, or artificial breast form, remains an option in the United States and
worldwide. Future literature review on the embodiment of an external breast prosthesis could also
contribute to the overall discussion on breast embodiment.

Lastly, given that the embodiment framework seeks to give space to an individual’s subjective experience, it
also opens space for alternative choices and narratives for patients who opt out of the decision to have
reconstruction or utilize prostheses. The Going Flat movement has brought attention to the option of
mastectomy alone, and outcomes on patient satisfaction have increasingly been explored . Evaluating
[71]
embodiment following mastectomy in this patient population warrants further investigation.

CONCLUSION
As advances in breast reconstruction progress, the goals of reconstruction may extend beyond anatomic
similarity and restoring sensation; these advances may also further patients’ goals of having an increased
sense of being one’s own breast. This review explored how the concept of embodiment can be understood