I complete here Peter’s answer with a characterization of physical maps as CPTP maps.
As you know, if the system is isolated, the only operations you can implement are the unitary operations. But, as you noticed, if you use an ancillary subsystem and throw a subsystem away, you can implement some other operations.
The set of physical operations are the completely positive trace preserving maps. (Following most of the literature, I’ll call them CPTP maps), and Stinespring’s dilation theorem indeed ensures that any CPTP map can be written as the partial trace of a unitary acting on a larger Hilbert space.
Since we are looking at non isolated subsystem, its quantum state has to be described by a density matrix $ρ$. In full generality, a density matrix has to be positive ($ρ≥0$) and having a unit trace ($\mathrm{Tr}ρ=1$). Let suppose we have a generic physical map $\mathcal{E}:ρ↦\mathcal{E}(ρ)$. To be physical $\mathcal{E}(ρ)$ needs to be a physical state for any input state $ρ$, that is, we should have $∀ρ:ρ≥0$, $\mathcal{E}(ρ)≥0$ and $\mathrm{Tr}\mathcal{E}(ρ)=\mathrm{Tr}ρ$. In other words, $\mathcal{E}$ has to be positive and trace preserving.
However, it is not enough. For example, the transpose $\mathcal{T}$, is a positive trace preserving map, which is unphysical. The idea is the one behind the Peres-Hordecki criterion: suppose you have a channel performing $\mathcal{T}$ on the thystem $A$. You can add another system $B$ of the same dimension, where you perform the identity $\mathcal{I}$ i.e. wher you don’t do anything. The global map on $AB$ is then $\mathcal{T}_A⊗\mathcal{I}_B$, which is not positive any more: some linear algebra shows $\mathcal{T}_A⊗\mathcal{I}_B(Φ_{AB})$ has $d(d-1)/2$ negative eignevalues, where $Φ_{AB}$ is a maximally entangled state.
For a map $\mathcal E$ to be physical, any extension of the form $\mathcal E⊗\mathcal I$ has therefore to be positive. This is the definition of complete positivity. The Stinespring dilation theorem then shows that this necessary condition is sufficient, since it gives a recipe to implement any CPTP map with an ancillary subsystem and and a unitary.