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!

This is awesome, but are you worried that you know what HN readers think about breast reconstruction aesthetics and that that may not exactly match the general population. Guess you can compare it to the first 1,300 responses?

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 for the insights Magnus, that can only come from an expert practitioner. I admire that you are so focused on helping your patients.

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!

Understandable but I'd argue that it's quite an important attribute - as it's known that post orgasm people's sexual drive/interest is/can be greatly reduced - and therefore what is stimulating will be different. I'd highly recommend having that additional field (that isn't personally identifying data either which is where I assume the concern is) if you run this experiment again - which I hope you do with better load times, things like different torso sizes - as proportion of breasts to torso size has an impact, etc. Still kudos to you for the work.

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!

After taking the survey, I must express two things that I've realized during the survey.

For one, my personal preference may not be the chest that is "more aesthetically pleasing" even though that is what the survey explicitly asks for. There are considerations other than aesthetics that should be considered. In my opinion, instead of the survey showing two cases (one perfect, one slightly afflicted), the survey should show just the afflicted chest and ask "is this aesthetically pleasing or not". Of course the perfect chest is more pleasing, but that does not mean that there was any problem requiring intervention on the other chest.

I've noticed that asymmetry with regards to breast size really are not a problem (for me), even in extreme cases. I've noticed this asymmetry in many women who have not had breast cancer or other afflictions. However, nipple asymmetry does stand out, especially vertical asymmetry. Two nipples at different heights does look terrible, and if aesthetics are an issue then I could understand performing surgery for those cases.

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!

  > As we also measure the decision time,

From very much experience in designing and running online interactions, including polls, I can tell you with authority that you cannot trust the decision time of answers online. You don't know that they user didn't look at a quick text message on his phone, or adjust the music volume, or go to the bathroom, or take a call, or had a network issue, or your images didn't load quickly, or the dog didn't bark suspiciously, or a loud C-130 just flew overhead, or any other of a million things. I highly suggest disregarding that feature.

Isn't that just noise? It's possible to extract useful signals from extremely noisy data if you understand the statistics.

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!

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