[HN Gopher] Improving breast reconstruction surgery with a web-b...
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Improving breast reconstruction surgery with a web-based survey
Author : magnusbaringer
Score : 46 points
Date : 2020-11-21 12:56 UTC (2 days ago)
(HTM) web link (magnusbaringer.com)
(TXT) w3m dump (magnusbaringer.com)
| Karawebnetwork wrote:
| I am part of the transgender demographic. Thank you for your
| work, for us it is life saving. A lot of trans people can only
| afford one surgery in their life time and so many complain of
| having received poor results. I hope your dataset improves the
| results of everyone, everywhere!
| magnusbaringer wrote:
| 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!
| roel_v wrote:
| Very cool research. I'm sure there are lots of people on here who
| would love an in-depth write up of how you construct these
| images.
| magnusbaringer wrote:
| 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!
| roel_v wrote:
| Oh I'm sure nobody expects you to write anything up tonight
| :) After getting along a bit further in the survey, I'm also
| interested in how you're going to approach the analysis of
| the responses, more specifically, how you're going to
| separate out the personal preferences of respondents, since
| I've had a few cases now where the choice was basically "do I
| find large breasts more attractive than smaller ones" - even
| if there were some minor other factors at play in the
| specific images. Anyway, good luck, although I do agree with
| some other posters that you might get more people to complete
| the whole thing if you'd show them fewer images; it takes a
| long time to get through a full round.
| adzm wrote:
| Will this data be available publicly? Also are the images tagged
| with metadata about measurements?
| magnusbaringer wrote:
| 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).
| gus_massa wrote:
| Does this need a NSFW tag, for people that live in a silly
| country?
|
| Are the position of the images randomized, or you show always the
| non-intervention version on the same side?
|
| It's a little too long. I'll try to complete it later.
|
| The images take too long to load, and you can see how they are
| constructed. It is slightly weird.
| magnusbaringer wrote:
| 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!
| gus_massa wrote:
| How many images are there in total? It looks like the images
| are generated from smaller parts that are downloaded
| separately.
|
| Perhaps you can download all the parts in hidden images and
| combine them on demand. Also, perhaps you can render the
| images in a hidden canvas while the user is selecting the
| previous pair of images, so when the user makes a click the
| change has no pause.
| conductr wrote:
| I took the survey. I see the value in this. Simply because
| aesthetics are important (big concern for patient) and maybe you
| could use data to help them make a big decision in a data driven
| way on which type of surgery to choose.
|
| As with other surveys like this, and perhaps eye exams, I found
| myself several times thinking "these two look the same", or "I
| have no obvious preference", or "I like both". I'm bringing it up
| because I think that's valuable data that should be considered.
| magnusbaringer wrote:
| 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!
| conductr wrote:
| Good to hear you thought of it, I would say that due to load
| time, the response measure should be suspect. Using myself as
| an example, I clicked, read some news, came back and clicked,
| go get a drink, etc. Took me over an hour to finish.
| magnusbaringer wrote:
| 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!
| revicon wrote:
| I tried, I really did, but this survey takes forever to load each
| photo. I finally gave up.
| magnusbaringer wrote:
| 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!
| XCSme wrote:
| I can confirm, it takes like 1-2 minutes for each new
| question to load on a very good internet connection (from
| EU).
| magnusbaringer wrote:
| Thank you very much for this feedback. I will try my best
| to improve that!
| Rick1 wrote:
| Indeed. The loading time far exceeds the time I spend actually
| making choices.
| tait wrote:
| Same here - any chance on getting it to pre-load _or
| something_?
| julienreszka wrote:
| why is it loading so slowly
| magnusbaringer wrote:
| 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.
| [deleted]
| danielh wrote:
| I followed the link before I read your comment. On mobile, I
| did not notice that there is any scarring or thought it was
| just rendering artifacts. I would expect your results to be
| skewed toward the more symmetrical images. Also, is there any
| reason why the survey takes five minutes? Why not limit it to
| 10 images, with the option to keep going? I really like the
| idea, I hope this feedback is valuable.
| magnusbaringer wrote:
| 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!
| wolverine876 wrote:
| I expect the following is not novel to you, but would you share
| how you address it with your patients and in this study?
|
| In my experience - not based on professional expertise - when
| people are very concerned about what others will think, in regard
| to any topic, it is due to a lack of self-worth or self-
| understanding. They want others to fill that hole, to provide the
| answer or esteem that they have trouble providing to themselves;
| they put enormous power in others' opinions. The solution is not
| to talk about what others think but to find help them find those
| things within themselves - how do _they_ feel about their choice,
| their action, their physical being.
|
| This study (which I understand might represent only one aspect of
| your strategy with patients) focuses only on what others think as
| an answer to the patients' uncertainty. It _seems_ to assume that
| the worth of the patients ' own bodies depends on pleasing
| others, that the value of this body part is as objects of
| pleasure for others. And of course we know well that our society
| sends that message to women, about this body party in particular,
| very often.
|
| And to avoid any misunderstanding, I'm not setting up some
| argumentative binary concept that people don't care at all how
| they look. To varying degrees, everyone cares. But I worry far
| more about the self-esteem and emotional health of the patients
| than I do about how their breasts look (Edit: And I assume you do
| too and are acting in good faith). For their breasts, the only
| person to please is themselves.
| ampdepolymerase wrote:
| Unrelated but which library did you use for the loading spinner?
| It is the exact same widget as the one used by the new Medium
| site.
| magnusbaringer wrote:
| 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.
| brian_c wrote:
| Disappointing that all the images are built on the same shade of
| white skin. You're leaving out a whole lot of folks who are
| already underrepresented in a whole lot of research. I think it'd
| be helpful to vary the skin tones shown, or stick to a medium-
| tone (enough to be ambiguous) grayscale.
| magnusbaringer wrote:
| 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!
| magnusbaringer wrote:
| 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
| Rick1 wrote:
| Slow loading times aside, looks well made.
| magnusbaringer wrote:
| Thank you very much for the kind feedback and your support! I
| will try my best to improve the loading times.
| DoreenMichele wrote:
| The landing page is safe for work. The survey itself involves
| looking at bare breasts, so is "NSFW."
|
| Breast cancer runs in my family. Two close relatives have had it
| more than once starting at early ages.
|
| My impression is you are barking up the wrong tree. What is
| "aesthetically pleasing" to random strangers according to some
| survey is of little importance.
|
| If she is in a serious committed relationship, her partner's
| opinions will be really important to her decision-making process.
|
| If she is really young, this will tend to matter a lot more to
| her than if she is older.
|
| Scarring is not just about aesthetics. It's about pain and
| swelling and limited movement and things like that. That tends to
| get short shrift by people in the business of selling you surgery
| for the purpose of improving your appearance.
|
| I started the survey but didn't finish it. It's boring and
| repetitive and I thought images were weird, starting with the
| detail that there are no arms. Like I'm supposed to care about a
| woman's breasts and not be bothered by the fact that she has no
| arms?
|
| As a woman who gets tired of some people acting like I am only a
| sex object and the only parts of me that matter are the parts
| covered by a bikini and as someone with a serious disability, I
| find details like that pretty insensitive and disturbing.
| conductr wrote:
| > If she is in a serious committed relationship, her partner's
| opinions will be really important to her decision-making
| process.
|
| 6 years since my wife's double mastectomy and honestly I'm only
| posting for potential benefit of anyone that reads this.
| Do/suggest/live-with/support what ever is least invasive for
| your wife/partner. I nearly steered my wife into a very
| invasive surgery due to it having more "real" outcome (she knew
| I wasn't really into implants in general and preferred
| natural). Honestly, I think she wanted that too - it's a hard
| time that leads you to this type of surgery and something that
| sounds "normal" is what you will gravitate towards. However,
| then I came to my senses/digested some research and realized
| how invasive the surgery was and how I didn't want her to have
| to go through it (+risks) and I had to kind of talk her out of
| it. It was the difference between, quickly adding some implants
| (couple hour surgery) and a procedure that required re-routing
| an artery, relocating some stomach muscles, and some other
| grueling things I don't recall (18 hour surgery).
|
| After that ordeal, and a C section birth of my son, yah she has
| some scars. But they become invisible and life moves on and
| that's the best part.
| roel_v wrote:
| Ugh, sometimes I wish I could double downvote some comments, or
| that there was some "come on, at least have some decency"
| moderation here. I mean, of course, you, a random internet
| commenter with no medical knowledge whatsoever knows better
| than a plastic surgeon who deals with patients every day what
| information those patients need most to make better decisions
| about what is, for many of them, the biggest decision they have
| to make about their bodies in their lives?
|
| "As a woman who gets tired of some people acting like I am only
| a sex object and the only parts of me that matter are the parts
| covered by a bikini"
|
| What a petty, misanthropic way of looking at the efforts of
| someone who is doing their best to help people (not just
| 'people', women, specifically) at often one of the worst points
| in their lives. I hope you just wrote this comment off the cuff
| and regret it after re-reading it after your coffee, because if
| this is really how you feel, I feel truly sorry for you for
| being such a bitter, nihilistic person.
| [deleted]
| gus_massa wrote:
| I agree with most of your comment.
|
| About the arms, I guess the problem is that for internal use in
| a Medicine class it is usual to make the torso without arms.
| For example half of these images don't have arms
| https://www.google.com/search?q=torso+medicine&rlz=1C1CHBF_e...
|
| If the survey was about hand reconstruction if a machine
| destroys your thumb, and they move a finger to the thumb
| position, I guess the image would have only the hand without
| the arm.
|
| Perhaps this can be solved with a more smart cropping. (The
| images don't have legs, but that part is cropped so it is not
| weird.)
|
| > _Scarring is not just about aesthetics. It 's about pain and
| swelling and limited movement and things like that._
|
| In some images I notice the scar and though: " _More symmetric
| is better, but that means an additional surgery. I don 't like
| surgeries unless they are absolutely necessary._" I don't
| remember what I selected, but it was a difficult choice because
| the question in the survey and my preferences have a different
| answers. I probably answer half following the instructions and
| half my opinion.
| DoreenMichele wrote:
| I agree that cropping could go a long way towards solving the
| arm issue. It's a small detail, but it could be handled more
| sensitively.
|
| Some women experience a lot of swelling after a mastectomy
| and my general understanding is this can be impacted by how
| many lymph nodes get removed. This can make tight clothing a
| nightmare that causes bad swelling and a lot of pain.
|
| This can be a really serious quality of life issue.
| Rick1 wrote:
| > What is "aesthetically pleasing" to random strangers
| according to some survey is of little importance.
|
| It's extremely important to most people. We go out of our way
| to look good. Just look at any shopping street. Clothes,
| makeup, gyms, etc.
| wolverine876 wrote:
| > It's extremely important to most people. We go out of our
| way to look good. Just look at any shopping street. Clothes,
| makeup, gyms, etc.
|
| It's a continuum, and I don't think it's 'extremely
| important' to many people at all in my experience.
|
| Far more people are not shopping and don't go to gyms, and
| shopping and gyms serve other purposes too. Also, when
| someone does those things to enhance appearance it doesn't
| mean it's 'extremely important' to them; I watched a sporting
| event over the weekend, went grocery shopping, and I post on
| HN, but none of those tings are extremely important or even
| important to me (beyond avoiding starvation).
|
| It's not binary; humans cover a very wide range - much wider
| than you or I experience or imagine.
| DoreenMichele wrote:
| For most people who aren't, say, professional models or
| actresses, what your bare breasts look like is something only
| a relatively small number of people are likely to know from
| first-hand experience.
|
| It's important to be socially acceptable in public with how
| you look. But what your breasts look like when you are naked
| is really not important to your social life per se.
|
| Someone I knew who chose to not have reconstructive surgery
| after a mastectomy once said about a mutual acquaintance who
| had a lot of cosmetic surgery for various reasons "She is
| covered in scars and only looks good in her clothes." The
| unstated subtext there being "I also look good in my clothes,
| even though I only have one breast."
|
| If your life partner is okay with it and you are okay with
| it, the rest of the world can butt out. It's a more
| complicated question for a relatively young single woman who
| needs to wonder about future potential romantic partners.
|
| I was quite plump at one time. There are men who like it like
| that and I have been fortunate to know such men.
|
| At the time, I was getting a lot of ugly feedback from
| "random internet strangers" about how desperately important
| it is for a woman to be thin.
|
| That experience informs my opinion that "What random internet
| strangers think about your naked body is of little
| consequence compared to actual intimate partners in your
| life."
|
| FWIW and all that.
| parineum wrote:
| The goal of not caring what other people think about your
| physical appearance is noble but naive and I'm not even
| really certain it's ideal.
|
| It's definitely something that people say in situations like
| this but if you'd ask literally anybody who's had a
| mastectomy if they could keep their breasts looking exactly
| the same before surgery as they did before, I guarantee that
| nearly all of them would want that.
|
| I think it's much more important to help people be confident
| in themselves with their new appearance than it is to tell
| them they are just the same as they were before. I think it's
| misguided to try and convince people that they didn't lose
| something.
| nacs wrote:
| After I answer a question, it goes back to the "Start the survey"
| screen every time (browser: Firefox v83)
| magnusbaringer wrote:
| 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!
| givehimagun wrote:
| Firefox v82 here and mine worked...except there were long wait
| times between images.
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