But the eye doesn’t necessarily gaze at what is beautiful

Yasmin Tayag

ItIt may not be immediately clear why plastic surgeons in Poland needed eye-tracking software to create better female breasts, as a study in the journal Plastic and Reconstructive Surgery described this week. You don’t need technology to tell you that women’s breasts get a lot of attention all on their own. Earlier this year, when gamers took part in the video game streaming network Twitch’s controversial Eye Tracking Challenge, which dared participants not to look at a woman’s cleavage, the joke was that participants knew they would fail.

But the new study is less about whether people stare at breasts and more about which parts of the breast — and why.

The paper, authored by a team of plastic surgeons at W. Orlowski Memorial Hospital in Warsaw, is the latest in a growing body of work aimed at developing an objective measure for breast aesthetics. It builds on the pioneering work of Stanford University surgeons who published the first paper on eye-tracking software and breast reconstruction in the same journal in March 2018, hoping to transform the art of breast creation into a quantifiable science.

When women undergo breast surgery, whether for cosmetic or reconstructive reasons, there’s no consensus on what makes a good-looking breast. That makes it hard to ensure that the patient will be happy with the end result. “How do we judge beauty? We basically ask people, ‘Hey, does this look good?’ That’s not really very objective,” Dr. Gordon Lee, a Stanford professor of plastic surgery and co-author of the 2018 paper, tells OneZero. Eye-tracking software, he says, quantifies where on the breast the eye wanders, how long it lingers there, and where it might go after. “It’s providing some evidence as to why somebody likes or dislikes something,” adds Rahim Nazerali, Lee’s co-author and assistant professor of plastic surgery at Stanford.

It’s important to realize that the eye doesn’t necessarily gaze at what is beautiful.

“It’s natural for our brains to be looking at things that don’t quite fit,” says Lee. “It’s almost like Where’s Waldo?: You scan a picture, and you’re looking for something that seems a little bit different to you.”

Lee, who specializes in breast reconstruction in cancer patients after mastectomies, says he came up with the idea to use eye-tracking software from similar studies on babies, who have an innate ability to recognize when a person is happy or angry from certain features on the face. The hope is that eye-tracking data can, similarly, reveal the specific characteristics of a breast that unconsciously “catch the eye,” like scars, asymmetries, or nipple placement, so that surgeons can tailor their procedures to create a more natural-looking breast — one that elicits a natural gaze he calls “symmetric scanning,” which is essentially looking at the breasts without fixating on any particular point.

In the Stanford study, 29 participants looked at pictures of breast reconstruction at various stages while cameras tracked their eyes. The images included breasts with or without scars and the nipple-areola complex (sometimes it’s not replaced during reconstruction), and a combination of both. Viewers tended to fixate on scars and nipples, and, notably, spent less time fixating on scars when the nipple was present on both breasts. The team took this as a sign that symmetric scanning is more likely to happen when the breast reconstruction includes the nipple-areola complex, even when scars are present.

“If something was not symmetric, if there was a scar, or there was something abnormal looking, it would naturally catch your eye,” says Lee. “But now we have data that can actually quantify what catches your eye.”

“Think if they were to do something like this, God forbid, with men’s penises!”

But sometimes, patients and surgeons might disagree on what this means, and those conversations can be difficult. A patient who wants their breasts to be bigger and higher on the chest, for example, might make that choice because “society has influenced them to think that way,” says Nazerali. The choice is ultimately up to the patient, but the Stanford team believes there’s value in considering data on which parts of the breast tend to attract an abnormal amount of attention.

Complicating this idea is the fact that different people gaze at breasts in different ways, so the data is prone to bias. Plastic surgeons tend to focus more on scars, for example, and patients are more concerned with overall shape. Perhaps surprisingly, the new study found that the general gaze of male and female subjects was “essentially the same.” But even with a large and varied sample, it’s impossible to control for the way society and culture influence the way we look at breasts, even unconsciously.

“By using that you’re saying, ‘We’ve been told by the general population this is the most attractive,’” says Helena Lewis-Smith, a psychology researcher at the University of the West of England, Bristol who specializes in body image in breast cancer patients. “It’s like it’s adding pressure. It’s putting everyone’s societal ideals on you.”

Society’s long history of disproportionately sexualizing women compared to men makes any attempt to optimize the female appearance a fraught endeavor, even if the intentions are good. “Think if they were to do something like this, God forbid, with men’s penises!” says Lewis-Smith.

While she accepts that the eye-tracking data can be used as a guidance, she cautions that breast appearance is just one of many factors that determine patient satisfaction, both in cosmetic and reconstruction patients. “It’s not just about how they look — it’s how they feel,” she says, noting that women who have breast surgery can lose the ability to breastfeed or to experience any sensation in the chest, and many experience decisional regret after having surgery. And having symmetrical nipples, she says, isn’t necessarily going to prevent that.

“At the end of the day, it’s really what’s important to that person,” she says.

But like babies who are naturally attracted to smiling eyes and lips, adults may be inherently drawn to certain characteristics of the breast, and Lee sees eye tracking as a way to help ensure that patients are happy with their appearance.

“Obviously, all of us view things differently, as far as what is really beautiful,” he says. “But things that are more symmetric tend to draw less attention than asymmetry.”

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