magnusbaringer

Dear HN-Community, Another quick update.

We launched this study not even 1 week ago - with our 4 week goal being 100 participants and our half year goal being 1000 participants. After sharing the study to friends and family, we were already able to reach 1.300 participants within the first 4 days - which was already mindblowing for us and exceeded all our expectations. With 1000 paticipants the data would probably already have been better then most research that has ever been done in this field.

Thanks to the support of this unbelievably kind and helpful community we have now reached more than 6100 participants, collected more than 160.000 votes and nearly 800.000 datapoints in our database. The amount of extremely valuable and helpful data is just beyond believe for us - and I cannot thank you all enough for all your support, effort and positive feedback! We are now on the edge of creating one of the most if not the most profound studies in the field of breast surgery ever - and the amount of extremely helpful knowledge we can get from the data is just overwhelming.

Thank you HN for this wonderful opportunity, all your support and all your fantastic feedback and kind help!

Thank you for your support, feedback and your thoughts. I totally understand your concerns - and in some ways I also share them. Of course patient advice should not (at least not more then to some extent) rely on "what everybody else thinks". But as mentioned above, for some patients it is a big support to atleast get an understanding what "in general" is seen as asthetically pleasing. Furthermore, decision taking is not just up to the patient. There are also many "surgical" decisions that have to be taken - sometimes even during surgery as not everything can always be planned in advance (e.g. tumor size is bigger -> more resection is need and thus reconstruction also changes). Decisions like "do we correct the areola asymmetry now that we see there is one after reconstruction" are quite common during surgery - and so far, decisions are mostly based on surgeon preferences unfortunately. If we can get a better understand on what parameters matter more for aesthetical perception, decision taking is improved in many different ways - not the patient-related part of it. I hope that explanation helps! Thank you so much for the great support!

Thank you very much for your time and support!

I do understand your concern - however the data collection works a little bit different "under the surface" as it seems. In the statistical analysis of the data we do not look at the "complete" breast images. The study is designed in a way, that the most important parameters around breast (reconstruction) surgery (e.g. breast size, breast shape, areola size, areola position, scars etc.) are being combined in 88 images in a way that in the end allows us to extract the data "broken down" to the different parameters. So the result of the study will not be "people like image X more than image Y". Instead we want to get a far more profound understanding of the influence the different parameters have on the perception of the breast. As we also measure the decision time, results of the study will be something like: "most people (or maybe just men - that's what we want to find out) tend to accept breast size asymmetry more then areola asymmetry. The decision happens much faster on areola asymmetries - so that seems to be more obvious and therefore has to be taken more care of during the surgery." Nobody has every done a profound analysis of these individual parameters alone - so that is where we see huge potential for a better understanding. I hope that explanation helps a little bit! Thank you very much again for your support!

Thank you for your support and interest in the project - and of course this thoughtful input. We have had hours of discussions on how many "metadata" we ask for. The two main reasons for the fact that we decided on just gender and age are on the one hand the more data you ask for, the less people will take the time and effort to start the survey (so we wanted to make the "barrier" for participation as minimal as possible). On the other hand, this study has been designed completely in alignment to approvals by the ethics committee of our university and they demanded us to gather as little as possible "personal" data of the participants. I hope that explanation helps a little bit. Thank you for your support!

Thank you for your interest and feedback. Yes - in some ways it is. We want to get a far more profound understanding of the influence the different parameters (e.g. size, shape, areola sizes, areola positions etc.) have on the aesthetic perception of the female breast. So in the end we would love to get results like: in case of a areola asymmetry, more people tend to accept a asymmetry than a correction when you therefore have scars. I hope that explanation helps a little bit. Thank you for your time and support.

Thank you very much for your time and support! It really means a lot!

Just a quick update: I have improved the code and think that I thereby was able to reduce loading times significantly. Thank you for your effort and patience - it really means a lot!

Thank you very much for your interest and support! In deed we were already aware of this study. However we want to get a far more profound understanding of the influence different parameters have on the breast. The study is designed in a way, that the most important parameters around breast (reconstruction) surgery (e.g. breast size, breast shape, areola size, areola position, scars etc.) are being combined in 88 images in a way that in the end allows us to extract the data "broken down" to the different parameters. So results of the study will be something like: in case of an areola size asymmetry, more people tend to accept the asymmetry then a size correction when you therefore have scars. I hope that explanation helps a little bit! Thank you very much again for your support!

Just a quick update: I hope to have improved loading times significantly with some code improvements. Thank you for your support!

Thank you very much for your interest in the study and your feedback! I do understand where your concern comes from. However, in the statistical analysis of the data we do not look at the "complete" breast images. The study is designed in a way, that the most important parameters around breast (reconstruction) surgery (e.g. breast size, breast shape, areola size, areola position, scars etc.) are being combined in 88 images in a way that in the end allows us to extract the data "broken down" to the different parameters. So the result of the study will not be "reconstruction is preferred". Instead we want to get a far more profound understanding of the influence the different parameters have on the breast. So results of the study will be something like: in case of an areola size asymmetry, more people tend to accept the asymmetry then a size correction when you therefore have scars. I hope that explanation helps a little bit! Thank you very much again for your support!

Thank you very much for your feedback and support! I already tested it from a "remote" location. I have optimized the code tonight and think I was able to improve performance significantly! I am very sorry for the inconvenience - but I never expected that amount of traffic on the site, so I was a little bit overwhelmed by that :-) But I hope that the issue is improved now!

Thank you so much for your effort and support! I have tried to improve the code and hope that performance is significantly better now. I am really sorry for the inconvenience! The good thing is that due to the study design and the database architecture, every vote (even if you clicked just one image) is taken into the statistic! So every click helps! Thank you so much for your effort! Greetings from Germany :-)

Thank you very much for your support! In fact now picture pair is equal - although some may look very similar. Some pictures may loop - but that is because we need to compare some conditions to the same "base" condition (e.g. size asymmetry from a C-Cup breast compared to an A-Cup and a B-Cup breast...so those two pairs are different, but the "base" of a C-Cup appears twice. The study is designed that way so that we are able to cover every important breast condition in one survey. I hope that explanation helps - thank you very much again for your support!

Dear HN-Community, Just a quick update after a very short night :-) Thank you so much for all the support, wonderful feedback and of course the time you take for this project! If just improved the code - so I hope that loading times are reduced significantly now! I apologize to all who have taken the survey so far despite the long loading times - I am very sorry for the inconvenience! Thank you for your effort in supporting this study! I hope the loading time issue is significantly improved now! Greetings from Germany, Magnus

Dear HN-Community, First of all I want to thank you all very much for all this wonderful support, kind feedback and overall interest in the study. I am completely overwhelmed by the amount of responses and interest. I try my best to keep up with all comments and feedback. It is nearly 23:00 o'clock here in Germany and I had a day full of surgeries - and my schedule for tomorrow is packed as well. So please forgive me if I have to grab a few hours of sleep and may not be able to answer all questions immediately. I will do my best to keep up with everything as good as possible!

Just a few additional information in general in response to some frequently asked questions.

The goal of this study is to get a more profound understanding of what aspects and factors of the female breast in connection with breast surgeries are being percieved as aesthetically pleasing.

Why is this so important? Of course we know that beauty is in the eye of the beholder - and surgery decisions are not based on aesthetics alone. But believe it or not - in the majority of cases patients are overwhelmed by taking decisions regarding the surgery of their own breast. Especially in case of breast cancer, the situation is so difficult and live changing for patients, that it's super difficult to take clear decisions or even just focus on own preferences. Other obvious factors like medical aspects or potential pain aside - for many patients it is extremely important to get profound pre-operative advice on what "generally" is seen as "aesthetically pleasing". E.g. do people like it more if there is a slight asymmetry after breast reconstruction - or is it better to do a correction but therefore have scars. There are many decisions that have to be taken - and for most patients it is very helpful to get good advice. Of course there are patients that know exactly what they want - and what their preferences are. However - as strange is this might sound - for the majority of patients that is not the case.

The goal of this study is to get a better understanding of what factors and aspects of the female breast and surgery conditions do have an influence of the aesthetic perception. The survey contains 88 picture pairs - no pair is equal (although some look quite similar). The order of the pictures is being randomized for every participant. The number of 88 pictures is the minimum number that we need to cover every possible "real-life" condition of a breast to get enable a profound statistical analysis. Some pictures might seem similar to you - but your decision allows us to gather a lot of data about why you took that decision and thereby better understand what factors really have an influence. In the end, we hope to find out what aspects do matter more than others - in order to then be able to give patients better advice (e.g. scars are percieved as more aesthetical than an asymmetry if the asymmetry is just one cup size).

We know that this study is not perfect - but as far is we know it is by far the most sophisticated study in this area so far. Therefore we hope that we can maybe gather new helpful data. And if only one surgery can be improved, we already helped one patient to get a better result than otherwise.

Therefore, thank you all very much for your support and time! I will do my best to reply to every comment and feedback! Thank you, Magnus

Thank you very much for your feedback and time! We know that we do not cover aspects like skin tone - and we would love to somehow implement that. The problem is that to get the best statistical results, the "decision-influencing" differences between images ideally have to be reduced to just the exact condition (e.g. different breast size). Every other additional variation (e.g. skin tone) would "blur" the data. As we need 88 picture pairs to cover all required breast conditions anyways, it is practically impossible to take any other aspects into the survey (e.g. skin tone) without completely exploding the number of pictures and blurring the data. So we apologize for that "inconvenience" - but we haven't found a better solution. Thank you very much for your support and feedback!

Thank you very much for this feedback. I will try my best to improve that!

Really? I am super sorry for that inconvenience - and even more thankful that you took the time to finish despite these enormous loading times. I will try my best to improve that! Thank you so much for that feedback!

Thank you very much for the kind feedback and your support! I will try my best to improve the loading times.

Thank you so much for your time, effort and support. I am very sorry for the inconvenience. I checked the server multiple times - despite the unexpected huge amount of traffic from HN the server still seems to be fine. So I am not sure what causes these long loading times for some participants. I am very sorry for that - I will try to my best to improve this somehow. Thank you again for your support!

Thank you for your interest and taking the time. Did you select a gender and age group? If one of those selections is not selected, you will be taken back to the landing page. Could this maybe cause the problem? Thank you for your support!

Thank you so much for your support and this kind feedback! We will do our best - and if only one surgery can be improved, we already helped one patient to get a better result than otherwise. Thank you for your time and support!

Thank you for your comment and interest! We will definately publish all data - after all we want to help patients and surgeons so we have to get all the data out to them! At the moment we are just a little bit overwhelmed by the amount of feedback and participants to be honest :-) But of course all data will be published! We have an email subscription box at the end of the survey - we will notify everyone who is interested as soon as we publish the data.

What exactly do you mean with metadata and measurements? Do you mean the breast sizes? The breast conditions are rendered from 3D-measured breasts of real patients - so the displayed conditions and breast sizes are completely based on real measurements and the corresponding measures (e.g. cup-size).

Thank you so much for this kind feedback! To be honest I am completely overwhelmed by the amount of responses and feedback - I never expected that. I will happily put together more in-depth information about how the project came to life and how everything works! I just have to try to keep up with all comments and responses first :-) Thank you for your support!

Thank you for your comment. I have used this spinner for 5 or 6 years already. It is just a GIF - to be honest I can't remember where I got it from back then.

Thank you very much for your time and feedback! The scars are indeed not too prominent. In fact we had ours of discussions about the intensity of the scars - in the end we decided to go for a scar intensity that equals the average scar after about 2 years (so they wouldn't be too obvious in reality either).

The survey has 88 picture pairs that are mixed randomly. These 88 pairs are the absolute minimum to cover all relevant breast conditions in a way that allows us to get good statistical data. We calculated the average decision time per picture pair with 3 seconds - hence the 5 minutes. However the survey is structured in a way that if a participant only clicks 10 pictures, we can still use the data from those 10 clicks. So every click counts - and if someone is kind enough to click all 88 pictures, we get a full set of data.

Thank you very much for your interest and support!

Thank you very much for your time taking part in the survey and your great feedback. That is exactly our goal - to help patients with decision making. Patients often are quite unsure about what is the aesthetically best option for them and want to know what people prefer in general - and the least we should be able to do for patients is give the good and research-backed advice.

We know that some picture combinations look very similar - however there are no duplicates in the survey. However of course, sometimes it is quite difficult to make a decision. But we also measure the time of every decision - so in the end we will be able to tell which aspects are quite obvious and therefore quick and easy to decide - and which are not.

Thank you for your support!

Thank you for your reply and your feedback. I'm not sure about the NSFW tag - however if you select age under 18 you cannot start the survey, so I hope it is ok without the NSFW tag.

The order of the images is completely randomized - so the survey is never the same for two participants. The images however follow a complex algorithm - no image pair shows up twice. The number of images - although admittedly quite high - is the absolute minimum amount to simulate every important condition/decision-combination relevant for surgery. The load time was optimized - however depending on your location and server load it might of course be a little to long (I try to further improve that). Thank you very much for your support!

Dear HN-Community, I know this might be a little different post - but we hope it might be appropriate nevertheless. I am a physician in reconstructive and plastic surgery with a passion for technology. A big part of my job is breast reconstruction (e.g. after breast cancer, malformations etc.). Usually, those surgeries are extremely stressful (and in case of cancer lifechanging) for patients - which makes decision taking very difficult for them in most cases. It is a fundamental part for surgeons to support and accompany patients on their way. Many important decisions have to be taken - by the patient as well as by surgeons. E.g. in case of an asymmetry after breast cancer patients have to decide whether they prefer to live with an asymmetry or an alignment, which, however, leads to scars. As simple as this decision may sound for you - for most patients it is not. Unfortunately, the is no realiable data and research on a larger scale so far, that allows surgeons to better understand what patients (and society in general) accepts as an "aesthetically pleasing" outcome.

Therefore I built a web based software, that is able to create relatively realistic models of various breast conditions - e.g. different breast sizes, asymmetries, scares and so on. I then built this software into a survey, that mixes different conditions in a pseudo-random way, that allows us to gather a vast amount of realiable data on a scale that has never been seen in this field of medicine before - which ultimately would significantly improve advice and also surgery for patients.

It would be awesome if you would sacrifice 5 minutes of your time to support this project.

I am looking forward to answering any questions. Thank you for your time and support.