Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Breast Cancer Rehabilitation A holistic approach to wearable product design LU CY G RU N F E L D 2023 An exegesis presented in partial fulfilment of the requirements of the degree of: Master of Design at Massey University, Wellington, New Zealand Inside Cover From “Equal Lens” by Sophie Mayanne Abstract Breast cancer is a devastating disease that affects millions of women worldwide, often resulting in traumatic experiences with lasting physical and emotional consequences. A significant challenge for breast cancer patients is finding well-fitting bras that accommodate their unique shapes, sizes, and healing requirements. Despite being one of the most engineered and patented ready-to-wear garments, functional bra designs still leave much to be desired, particularly in postoperative care. In addition, the current focus on functionality over emotional connection neglects their unique physical and physiological healing requirements, resulting in a lack of suitable options and exacerbating feelings of self-consciousness and anxiety. This Master of Design research drew on the intersections between appraisal theories, co-design processes, and empathetic design methodologies to develop a comprehensive understanding of how to design bras that address breast cancer patients’ physical and emotional challenges. The method employed a multi-stage human-centred co-design practice to ensure original quantitative and qualitative insights and validations provided by all stakeholders throughout the design development. It highlighted the importance of interdisciplinary design incorporating fashion, textiles, design, and manufacturing processes to create a more personalised and effective solution that addresses the complex needs of the user group—combining innovative technologies, 3D body scanning, 3D knitting, 3D printing, and wearable technology, alongside specialised CAD software allowed for an iterative design process that streamlined development and manufacturing workflows. Contextual research compared, contrasted, and identified the gap between contemporary and traditional bra fit and design methods. In addition, it considered the challenge of innovating a product ingrained in our daily lives, aiming to inform future developments and increase engagement and awareness surrounding the wearers’ rehabilitation, identity, and individual fit. Design, in addressing these challenges, can provide a more holistic approach to patient rehabilitation and lead to improvement in their quality of life. Firstly, I would like to thank my Godmother, Janet Coulombe- who would’ve thought a discussion in 2016 about the problems of postoperative products would have led to me spending more than two full years exploring bras? I would like to thank all the experts and patients who have given me their time and invaluable insights; without you this project would not have been possible, and not nearly half as rewarding. Jyoti Kalyanji and the AUT Textile & Design Lab – “my Auckland family” as they have been referred to. The Emerging Innovator Program and Massey Ventures who have provided mentorship, broadened my knowledge and supported me throughout this process. To my Massey-based supervisors and technical staff who have supported me emotionally as well as technically. My family, friends and partner. It takes a village to do a ‘masters.’ ACKNOWLEDGEMENTS 7 Fig 1. The postoperative bra my godmother wore that started this project. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 9 B A C K G R O U N D Background Throughout history, the design of bras is intertwined with the social status of women. In 1890s Europe, underwear’s primary purpose was to conceal and symbolise “moral virtue” (Lynn 9). By contrast, during the second- wave feminist movement of the 1960s and 70s, the bra represented sexual repression as women subverted “rules about gendered dress” (191). At the same time, the garment has also been marketed as facilitating seduction (Greggianin et al. 2). Furthermore, the 1970s brought an increase in female participation in sports, which required the development of performance garments to reduce breast movement and pain during the continuous and repetitive movements of physical activity (Gorea 3). The design development of a bra must consider not only its practical use but also its symbolic, psychological and social significations. Thus, bra fit and design research spans many disciplines, from design and usability to human anatomy and anthropometrics, pattern design to textile engineering and sports to health sciences. Breasts are symbolic of womanhood, motherhood, and femininity. For some women, the loss of a breast can negatively influence self-image, self-identity, and perceptions of sexuality (Crompvoets 137). This is reinforced by a bra industry that doesn’t consider long-term wearability and adjustability for uneven breasts, positioning the post-surgical body as “both physically and emotionally incomplete” (141). Furthermore, these specialist products have been predominantly designed without input from their wearers and thus generate unmet needs and dissatisfaction (LaBat et al. 308). In more recent years, the emerging concept of value-based health care has encouraged a paradigm shift toward care that prirotises the needs of patients. When used to inform wearable product development, a value-based health care approach can facilitate an empathetic co- design practice and ensure product design that meets the needs of all stakeholders (317). Several existing design and research developments aim to promote acceptance of the post-breast cancer body, moving away from the traditional social obligation to cover up. These include the unique TomBoyX Holdster bra, explicitly designed to support women with only one breast, advertising campaigns such as “Obsessed with Breasts” (Fig. 2) and research such as “Reconstructing the Self” and “After the Cure,” which gives voice, validation, and acceptance to breast cancer survivors (Crompvoets; Abel and Subramanian). These developments can empower women and create more realistic post-surgery expectations that may result in a less significant decrease in quality of life. In earlier projects, this researcher explored how technologies can be combined to enhance bra design to meet the diverse healing and psychological needs of breast cancer patients. Key insights highlighted the need for garment adjustability, design that anticipates patient needs, and collaboration between medical professionals, designers, and end-users. Another insight is the lack of female involvement in bra development, resulting in a lingerie market with an arbitrary sizing system, stimulating body dysmorphia and promoting the acceptance of everyday discomfort (Chen et al. 696). Explorations in this project involved an introduction to knitting technology, garment design, silicone strap moulding, and medical product development. This research extends on this work and draws on intersections between appraisal theory and empathetic design methodologies to inform the design of a postoperative bra that meets the requirements from a medical perspective, alongside the emotional needs of breast cancer patients. It utilises a co-design practice, ensuring insights and validations are provided from all who interact with the postoperative bra throughout the design development. Ultimately, it aims to increase the quality of life in rehabilitation. Aims 01 04 02 03 To assess changes and associated problems with breast cancer patients’ posture, mobility, and psychology and how these can influence bra design. To analyse breast cancer patients’ perception of bra comfort, through a selection of designs, orientations, and material choices. To create a design and development approach for postoperative bras, to enhance fit, donning and doffing and improve the physiological and wearing comfort of bras. To formulate a series of bra prototypes to evaluate fit, comfort and functionality. Fig 2. “Obsessed with Breasts” campaign CONTENTS CHAPTER 01 INTRODUCTION 13 1.0 The Role of the Postoperative Bra 14 CHAPTER 02 CONTEXT REVIEW 20 2.1 Section I. User Experience 22 2.1.1 Emotional Connection 23 2.1.2 Appeal & Comfort 23 2.1.3 Sourcing Experiences 24 2.1.4 Mobility Changes 24 2.2 Section II. Advancing Technologies 27 2.2.1 3D Scanning 28 2.2.2 3D Printing 28 2.2.3 3D Knitting 30 2.2.4 Wearable Technology 32 2.3 Section III. Bra Manufacturing 35 2.3.1 Pattern Making 36 2.3.2 Bra Design 39 2.3.3 Postoperative Bra 44 2.3.4 Sizing 45 2.3.5 Seamless Bras 45 2.3.6 The Role of CAD 46 2.3.7 Materiality 47 CHAPTER 03 METHODOLOGY 50 3.1 Co-design Process 52 3.2 Ethics & Empathy 52 3.3 Primary Participant Selection 53 3.4 Secondary Source Selection 53 CHAPTER 04 METHODS 57 4.1 Digital Questionnaire 58 4.2 Interviews + Design Review 58 4.3 Body Scanning 58 4.4 User Testing 58 CHAPTER 05 RESULTS 62 5.1 Procedure Background 64 5.2 About your Bra 64 5.3 Bra & Health 65 5.4 Bra & Prosthetic 65 CHAPTER 06 CONCEPT DEVELOPMENTS 70 Design Criteria 72 6.1 Section I. 3D Knit Developments 74 6.1.1 Knit Stitch Structure Experimentations 76 6.1.2 Knitting a 3D Form 82 6.2 Section II. Fastening Systems 89 6.2.1 Fasteners 90 6.2.2 Donning & Doffing 96 6.3 Section III. Increased Customisation 101 6.3.1 Shape 103 6.3.2 Colour 106 6.4 Section IV. Wearable Technology 109 6.4.1 Sensor Testing 110 Concept Evaluation 116 CHAPTER 07 FINAL DESIGN DEVELOPMENT 120 7.1 Final Design Concept 122 7.2 Crossover VS Centre-front 125 7.3 Virtual Participant Fitting 126 7.4 Colourways 130 7.5 User Testing 132 CHAPTER 08 BRA+VE 134 8.1 In-use Images 138 CHAPTER 09 DISCUSSION & CONCLUSION 142 9.1 Evaluation 144 9.2 Discussion 146 9.3 Recommendations 150 9.3 Reflection 154 CHAPTER 10 FIGURE LIST 157 CHAPTER 11 WORKS CITED 161 CHAPTER 12 BIBLIOGRAPHY 167 CHAPTER 13 FURTHER WORK 174 CHAPTER 01 Introduction B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n IN TR O D U C TI O N 15 C H A P TE R 0 1 INTRODUCTION The Role of the Postoperative Bra Breast cancer is the most frequently diagnosed cancer worldwide (“Breast Cancer Statistics”). Treatment often includes surgery to remove part or all the affected breast. Breast cancer surgery ranges from a lumpectomy, removal of a mass of tissue including the tumour, to mastectomy, removal of the entire breast and adjacent tissue. Lymph nodes may also be removed from the axilla in both procedures, heightening the chance of the onset of chronic lymphedema (abnormal swelling in the chest area). After recovery from surgery, additional treatment or surgeries may also include reconstructive surgery, radiation therapy, chemotherapy or hormonal therapy. All of these have ongoing side effects and complications (LaBat and Ryan 196). After a surgical breast cancer procedure, postoperative dressings in the form of a bandage or a bra are immediately secured over the scar tissue and up to the armpit These are required to avoid local complications, such as bruises, lymphatic collections, and reduction of postoperative pain. Breast dressings are often worn for one to two days; after this, they are often replaced with a postoperative bra. A postoperative bra supports the breasts, keeps the shoulders back and relaxed, and can prevent the development of skin lesions, osteomuscular pain, costoclavicular syndrome, respiratory failure, circadian rhythm disorders and lymphedema (Carrillo et al. 179) Lymphedema onset, either immediately or years after the surgical procedure, in the breast, hand or arm remains one of the significant long-term complications of breast cancer treatment, affecting more than one in five of all patients operated on (Ezzo et al. 2). Compression is a very effective method in the treatment and prevention of lymphedema (Ochalek et al. 347). Bras that provide compression are often recommended to be worn 24/7 for at least three months following surgery (Rogina-Car et al. 636). Considering that the primary purpose of compression in a postoperative bra is to prevent excessive build-up of fluids, it is important to understand where lymphatic collections are likely to occur to ensure that these areas are targeted for compression. The central lymph nodes are situated at the base of the axilla and collect fluid from the anterior, posterior, and lateral groups, and drain to the apical lymph nodes (Fig. 4). Management of a breast cancer tumour may include infection, irritation or surgical removal of lymph nodes, which can damage the lymphatic drainage system, causing an excessive build-up of fluid (Kyriacou and Khan). To reduce the onset and symptoms of lymphedema, manual lymphatic drainage treatment, in the form of compression and massage, can be targeted to the underarm, chest and back regions to reduce abnormal swellings (Ezzo et al. 2). Although a postoperative bra is recommended to be worn 24/7 for three months after surgery, user satisfaction with these bras can influence their wear time significantly. For example, in primary research undertaken previously by this researcher, only 31.8% of participants wore their bras during sleep due to discomfort (Grunfeld 23). Additionally, although compression bras’ aesthetic qualities often reflect their short-term medical purpose and physiologically mirror the trauma of a breast cancer procedure, forty-five percent of patients still sporadically wear these bras over three years after their surgery due to an inability to find comfort in regular bras and treat symptoms of lymphedema (25). This project proposes that a more user-centred design process that identifies the features important to breast cancer patients will result in a postoperative bra that promotes wear during sleep as well as encouraging long-term use. Fat Mammary gland Areola Nipple Milk duct Pectroralis major Ribs Fig 3. Breast Cross Section Lymphatics of breast Apical lymph nodes Central lymph nodes Lateral lymph nodes Posterior lymph nodes Anterior lymph nodes Fig 4. Axillary Lymph Node System IN TR O D U C TI O N 17 C H A P TE R 0 1 Breast Cancer Journey Diagnosis Wound CareTreatment Breast Care Products 2 — 4 Weeks Additional Treatment Options Breast Care Products Recovery 2 weeks — 3 years+ B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n C H A P TE R 0 1 IN TR O D U C TI O N 19 Fig 5. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 21 C O N TE X T R E V IE W C H A P TE R 0 2 CHAPTER 02 Context Review SECTION I. SECTION II. SECTION III. USER EXPERIENCE ADVANCING TECHNOLOGIES BRA MANUFACTURING METHODS Section I explores women’s postoperative experiences, how tangible product attributes correlate to intangible emotional connections between garment and wearer, and the changing attitudes toward the appeal of bras. This section will evaluate the garment requirements from a non-breast cancer perspective and investigate how these relate to the unique demands of surgical and healing-related side effects. Section II addresses new technologies that may be used within the scope of this design practice to improve functional qualities, aesthetic appeal, comfort, fit and bra development. Finally, section III outlines the design process of the typical postoperative bra, including traditional and contemporary methods of bra construction, sizing parameters, pattern development and design innovation. The discussions in this section will inform the development of a postoperative product that ensures a better quality of life for patients. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 23 C O N TE X T R E V IE W C H A P TE R 0 2 SECTION I. User Experience Although bras have been around for hundreds of years, incorrect and uncomfortable fit continues to be reported in women across a range of sizes, negatively impacting woman’s health (Coltman et al. 79). Several factors contribute to incorrect bra fit, including insufficient knowledge of how to fit a bra, and a lack of standardised sizes across manufacturers (79). A poor-fitting bra can result in discomfort, muscle fatigue and pain. In addition to these problems, breast cancer patients have supplementary surgical and healing-related side effects that must also be accommodated. Postoperative bras that do not accommodate these needs can create negative experiences with wearing and sourcing that reduce self-esteem further. Within this area, comfort, ease of use, adaptability, and functionality can work towards creating a positive experience and determine a product’s success and longevity. Users’ emotional experience with products can be understood from a cause-effect perspective, generally referred to as appraisal theory (Greggianin et al. 2). Within bra design, ‘appraisals’ can relate to the technical attributes of a bra; its function (closure method, wings, reinforcement, underwire, under-band, band, straps and model) and aesthetic (prints, texture, colour). Product success is dependent on understanding how evaluations of the physical characteristics of products (appraisals) can stimulate positive emotional connections. A research study published in 2018, containing insights from 182 women, discovered that positive experiences with bra use are directly related to the ability of the user to feel in control of the situation of wearing a bra (Greggianin et al. 5). Therefore, product interaction has to be tailored to align with the users’ own requirements. Positive emotions are triggered predominantly by the functional aspects of a bra as a poorly fitting bra can lead to muscle fatigue, discomfort and pain. Additionally, allowing the user to have control over the aesthetics (colour, texture and pattern) associated with the bra can improve emotional connection (6). For breast cancer patients, bra discomfort is predominately related to functionality issues accommodating asymmetrical breast sizes, skin sensitivity, swelling fluctuations and body image (Gho et al. 774). Thus, allowing the user to be in control of these functional characteristics by offering user- adjustable cup sizes and closure methods alongside aesthetic customisations would work towards triggering positive emotional connections. 2.1.1 2.1.2 EMOTIONAL CONNECTION APPEAL & COMFORT Traditionally, bra choice for women ages forty-five to sixty-five was thought to be determined primarily by aesthetics, followed by comfort and support. The conclusion from a 2012 study involving focus groups and interviews with thirteen women was that a bra “needs lace to be attractive” (Risius et al. 270). This belief has been reinforced by a lingerie industry that predominantly uses plastic-based fibres such as artificial lace and nylon, which when worn for long periods of time can interfere with hormones and cause adverse reactions in the body (Nguyen and Saleh 5). More recently, lingerie retailers are emphasising the importance of comfort in intimate apparel as it is in contact with the skin directly, acting as a barrier between the skin and outerwear. It is stated that both healthy-breasted women and breast cancer patients now “value comfort over every other bra preference” (Wroblewski et al. 41). However, comfort and fit are highly subjective terms that require a deeper understanding. In this project, comfort refers to the harmony between a human’s physical, physiological and psychological sentiments and the environment. Low comfort can negatively impact garment performance and cause physiological loads which may deplete the “physical and mental capacity of the wearer” (Sena Cimilli Duru et al. 2). Thermal comfort is of particular importance for those affected by breast cancer as these patients tend to have extreme problems with body temperature regulation post-procedure. Despite this, the limitations of thermal and humidity regulation of wearable postoperative products have been reported for over a decade (Leung et al. 2). Reconstruction patients (patients who have an implanted breast prosthetic) tend to suffer from ‘cold breasts,’ and can accidentally burn their tissue in an attempt to heat them up with external heat sources (e.g. heat pads) due to low sensitivity (Wroblewski et al. 3). Additional treatment can also induce crash menopause, causing more frequent and severe hot flushes that create problems sleeping and increased pain (Leung et al. 2). To ensure a thermal balance between the body and the environment, product development must take thermal comfort into account through the exploration of human sweat maps, material temperature-regulating characteristics and fabric structures that stimulate heat transfer away from the surface of the skin. Body sweat maps for female runners reveal that the centre front area between the breasts and the underbust area is likely to accumulate the most sweat (Gorea 39). As bras are worn directly on the skin, it is important that the materiality or structure of a bra offers thermal regulatory properties in these areas. Fig 6. Female sweat maps B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 25 Finding a comfortable, well-fitting, and supportive bra is an integral part of regaining a sense of normality and improving physical and psychological well-being after breast cancer surgery. While it is reported that a well-fitting bra can improve postoperative body image and quality of life, fifty-two percent of patients are dissatisfied with the bra they wore after surgery (Nicklaus et al. 2). This is because the channels to access this product are fragmented, with only forty- five percent of sixty-eight patients surveyed receiving a prescription for a specific style of postoperative bra from their surgeon, and fifty-seven percent not receiving any advice on what bra they should wear after surgery (3). Patients who receive no guidance often buy multiple bras before finding a satisfactory one, choose bras that are unable to meet their healing needs, or forego wearing a bra altogether, which can have detrimental healing consequences. To increase accessibility within both the medical and commercial systems where postoperative products operate, resources and programs should be utilised. For example, “Reach to Recovery,” an online initiative run by the American Cancer Society, matches current patients with ‘survivor’ volunteers who offer support and first- hand insights throughout the breast cancer journey, to help patients select products that best meet their needs (LaBat et al. 311). Additionally, correct sizing is a significant issue if buying through online lingerie or medical product retail sites. To ensure success, a postoperative bra purchasing system should involve collaboration with a certified fitter, who can instruct women on how best to measure themselves for correct fit. While the product itself should offer understandable sizing (through instructive self-measuring videos), adjustability for different body shapes and support and acceptance for patients who choose not to wear prosthetics in their bras is also important (Nicklaus et al. 3). 2.1.3 2.1.4 SOURCING EXPERIENCES MOBILITY CHANGES Seventy to seventy-five percent of breast cancer diagnosis affects women aged fifty-plus (“Breast Cancer in NZ”). A common consequence of ageing is decreased joint flexibility and range of movement, which is reduced further by surgical breast cancer procedures (Zhang 16). Most regular bra closures are located at the centre of the back of the bra, resulting in most women facing serious difficulties securing these closures due to reduced flexibility and movement of the arms and fingers post-surgery (I). Additionally, side effects from treatment, such as lymphedema, can cause a loss of kinematic senses in the hand, with 65.3% of patients struggling with daily activities (Karadibak and Yavuzsen 1674). This can negatively impact the wear experience of the daily activity of donning a bra, which often comprises the conventional hook and eye fastener. The small size of these fasteners makes locating and fastening difficult (Zhang 136; Nicklaus et al. 3). Thus, this research will draw on the design and developments of age-friendly bras (Zhang) and arthritic-friendly bras (McCoy), whose works include the developments of larger, magnetic fasteners. The development of such fasteners is aimed at ensuring a fastening system is developed that is reliable and easy to do up and adjust with the limited hand mobility that is an evident side effect of a breast cancer procedure. Another effect of ageing is the decrease in central and peripheral neurons, skeletal mass, and muscle tissue efficiency. A gradual increase in the fragility of connective tissue and muscle strength causes changes in the balance of body weight, impairing the physiological curvature of the spine (Zhang 13). This posture change results in back pain due to the increase of breast gravity vertically. Range of motion (ROM) refers to the movement of joints from full flexion to full extension. Reduced range of motion is a common side effect of a breast cancer procedure due to the removal of lymph nodes in the axillary region and the requirement for additional treatment. In particular, the mobility of shoulder joints significantly influences the donning and doffing of a bra (Fig. 7). Due to this, bras designed for women with breast cancer are often designed with front closure styles. However, these bras tend to have limitations in support and adjustability. Often one line of front fasteners at the centre forces patients to wear a prosthetic to achieve a supportive fit, which can be heavy and uncomfortable (McGhee et al. 86). 115º 20 o 30º 15 º HEA D R OTA TI ON SHOULDER ROTATION40 º15 º PO ST URE | F LE XIO N ARM SWING 100º 40º 1 2 3 4 5 6 7 1 7 6 Shrugging bra on Front fastening Shoulder strap tightening Pain point Optimum rotation zone Analysis point# Shoulder rotation backwards is too significant. Elbow flexion is passed comfortable position. Back posture is at a maximum backward angle to shrug bra on. Arm cannot extend above shoulder height. Neck is hunched over to increase line of sight so brafasteners can be located. Back posture is hunched over to locate fasteners. Arms are passed maximum shoulder rotation to reach to the back. Extend the length of shoulder straps to reduce backwards stretch. Extend the distance between straps to reduce elbow flexion. Extend the length of shoulder straps to reduce backwards strain on elbows. Over the head bra donning would not be possible. Increase ease of locating front + shoulder fasteners to reduce neck and back strain. Bring shoulder strap adjustments further towards the front of the body to reduce shoulder and back strain. 1 2 3 4 5/6 7 1 2 3 4 5 6 7 C O N TE X T R E V IE W C H A P TE R 0 2 Fig 7. Donning/doffing experience SECTION II. Advancing Technologies Technological advancements in relation to the production of lingerie generally relate to textile advancements resulting from advanced fibres and performance fabric technologies. However, given the variety of breast shapes and the complexity of generic pattern-making to accommodate these shapes, breast cancer patients have expressed many unmet needs regarding their bra choices after breast cancer treatment (Nicklaus et al. 272). In addition, breast asymmetry is a challenge that is amplified after any procedure, with dramatic changes in volume resulting in a bra being unable to support the breasts properly. One approach currently being investigated to provide a unique fit is 3D scanning, which is used to identify trends and inform designers of generic adjustments needed in pattern designs (279). Technology advances such as 3D scanning, 3D knitting, 3D printing, and wearable textile sensors will be explored throughout this project to allow more adjustability and customisation in bra design. All of these are accessible locally for commercial production and prototyping. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 29 C O N TE X T R E V IE W C H A P TE R 0 2 3D scanning is used to take fast and accurate measurements of a physical object, structure, environment, or person and then uses that data to construct digital 3D models. The scan is non-contact and uses light from a laser to generate digital contours. This technology can be faster than taking individual body measurements and can reduce the challenges present in taking personal measurements, creating digital forms that can be referred to throughout the design process. 3D scanning has been used previously to identify trends in breast measurements from reconstruction patients before and after their surgical procedure (Nicklaus et al. 272). However, it could also be used to map weight and swelling fluctuations at multiple stages in recovery to determine the adjustability required in a postoperative bra and allow designs to be drawn directly on the digital form. 3D Body scanning is used in this practice to collect the measurement data of breast cancer patients and allow developments to be trialled and fitted virtually before physical prototyping. 2.2.1 2.2.2 3D SCANNING 3D PRINTING 3D printing or additive manufacturing is the process of making complex forms from a digital file. This process is being used more significantly in the medical and lingerie industries in the production of prosthetics, implants and underwires. For example, MyReflection (Fig. 9) uses a combination of 3D printing and 3D scanning to form breast prosthetics that perfectly match a patient’s chest wall, Ossis (Fig. 8) uses 3D imagining to build custom titanium 3D printed orthopaedic implants, and Ari van Twillert (Fig. 10), creates bespoke, decorative and supportive underwires that align to a 3D scanned body. A combination of these processes allows for customisation in one-off and batch production. As adaptability is at the forefront of requirements for breast cancer patients, these technologies can be utilised to rapidly produce prototypes that sit more comfortably on the skin. SLA and FDM printing are used at every stage in this product development with various printing materials to iterate and test innovative fastening systems. Fig 8. Ossis Titanium 3D Printed Implant Fig 9. My Reflection 3D Printed Silicone Prosthetic Fig 10. Ari van Twillert Custom Underwire 31 In knitting, continuous lengths of yarn are converted into intertwined loops by hand or by machine. The development of electronic sensors and computers has shifted knitting technology into the digital design space. Semi- or fully-automated flat and circular bed knitting machines can feed multiple yarns through tensioning mechanisms to a knit carriage, that in turn sends yarn to needles to create knitted fabric. This process allows for the “computer-to-knit” production of 3D-shaped garments, with minimal cutting or sewing required (Lau and Yu 55). Digital knitting is one of the most popular techniques of large-scale garment or fabric formation. However, it has limitations; most knit software only provides basic manipulation to set patterns for socks, jumpers and tops, while novel designs rely highly on technical skill and trial and error (58). As value is being placed further on fit and feel, 3D knit is increasing in popularity in the intimate apparel markets. This is because, unlike conventional bra manufacturing, 3D knitting allows the creation of designs without sewing or seams. This feature meets breast cancer patients’ physical needs as they find that seam lines irritate scar tissue and sensitive breasts (Gho et al. 780; Nicklaus et al. 3). Additionally, this technique can shorten the manufacturing steps required, allow for more customisation from a user’s perspective and reduce material waste as only the part that is knitted is required. Knitted garments also have physiological benefits, offering tactile comfort to the wearer (Atalie et al. 1699). 3D knitting is already being used in bra manufacture to create the fairly standardised and recognisable pullover knitted bra (Fig. 12). However, this product’s low support means that it is not seen as an everyday bra as it tends to flatten the breasts (Lau and Yu 58). 2.2.3 3D KNITTING Fig 12. Typical pull over knitted bra Fig 13. “Soft Revolt” 3D knitted bra C O N TE X T R E V IE W C H A P TE R 0 2 Understanding the importance of a comfortable yet supportive bra, Soft Revolt has spent several years and forty-seven iterations developing its first almost entirely 3D knitted bra (Fig. 13). This bra differs from alternatives on the market due to its use of varying knit structures that increase support without the requirement of an underwire. This example demonstrates that an iterative testing and development process, exploring innovative yarns, different stitches and machine tensions, is required to exploit this technology successfully. The outcome of previous research (Fig.11) completed by this researcher in their Industrial Design Honours Degree provided an introduction to knitting technology. It consisted of building an understanding of tubular and interlock knit structures to create integrated pockets for the silicone-based co-moulded strap and lymphatic compression components. This practice-based research aims to build on this knowledge and continue to explore 3D knitting capabilities through experimentation with structures, yarns and tensions, among other bra manufacturing techniques, to ensure beneficial support and materiality characteristics in a postoperative bra. Fig 11. The starting point (Grunfeld) B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 33 C O N TE X T R E V IE W C H A P TE R 0 2 After breast cancer surgery, shoulder dysfunction, including weakness, postoperative pain, joint instability and limited range of motion, can often occur. Due to this, patients may suffer difficulties in everyday activities, resulting in a reduction in their quality of life (Park et al. 1). Exercise and movement are reportedly effective for improving mobility. However, side effects of breast cancer treatment such as scarring, lymphedema and reduced functionality contribute to bra discomfort and act as the highest barrier to exercise, leading to poorer health outcomes (Gho et al. 739). Due to the challenge of undertaking physical rehabilitation, wearable technology is a particular behavioural intervention device that is being refocused to support and encourage breast cancer patients. Studies on the approachability of wearable activity trackers acknowledge the various barriers to utilising this technology, including lack of understanding and technology skills amongst older adults (Nguyen et al. 3376). Patients also expressed concerns that wrist-worn trackers also may cause discomfort for those who suffer from lymphedema (3381). To increase awareness and approachability surrounding rehabilitation, simple features, such as step counting and monitoring, that are paired alongside other behavioural change techniques are required. This research will explore the applicability of utilising wearable technologies within wearable product design to reduce patient discomfort in postoperative monitoring and encourage physical rehabilitation. Additionally, the recent development of conductive-fibre-based stretch sensors that can accurately measure tension through deformation could potentially monitor the changing of swelling/inflamation levels, thus, alerting the patient or their medical overseer if swelling remains the same or is increasing. Furthermore, when abnormal swelling patterns are combined with increased heat, these could signify an early indication of the presence of infection (Chen et al. 7204). A practical example of a stretch sensor system used to measure the effectiveness of a lymphedema compression sleeve is Leap Technology’s elastic sensor, a malleable stretch sensor used for measuring the circumference of lymphatic swelling in a patient’s extremities (Fig. 14). While refocusing a stretch sensor into a postoperative bra offers reduced discomfort in non-invasive, postoperative patient monitoring, there are several challenges surrounding approachability, optimal placements of the sensor and its componentry, accurate calibration, durability of the sensor and increased bra cost that will need to be further explored through the design development. 2.2.4 WEARABLE TECHNOLOGY Cloud storage Data collection Stretch sensors Caregiver alert Data handling Fig 14. Leap Technology’s stretch sensor system SECTION III. Bra Manufacturing The predominant dissatisfaction with bra use in women stems from the lack of customisation and sizing disparities within ready-to-wear clothing design (Bye et al. 76). Regardless of breast cancer status, up to 85% of women are reported as wearing incorrect bra sizes (Nicklaus et al. 2) due to limited knowledge on how to fit a bra themselves, and ready-to-wear clothing being unable to accommodate naturally occurring breast asymmetry. Breast cancer patients have specific needs for comfort based on their situation and activity level. All procedures lead to the formation of sensitive scar tissue in different areas that can impact bra selection. Reconstruction patients, particularly, are prescribed to forego underwire altogether due to the potential puncture risk to their implants (LaBat et al. 315). As typical bras are fitted to the larger breast, often the treated breast of a Lumpectomy patient does not completely fill a bra cup, which can cause aesthetic problems such as gaping or functional problems such as reduced support during movement (Gho et al. 740). Due to this, this section will focus on the design and manufacturing of postoperative bras, underwire-free bras, and specialised bras, such as maternity or bras designed for the elderly. As there is little literature on how design influences the fit of a bra, this section will consist of product dissection alongside literature dictating recommendations for improved design strategy. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 37 There are various styles of bra that offer unique fitting challenges. Two that differ significantly are sports bras and everyday bras. Sports bras provide full coverage, are designed to provide compression and hold breasts in place during movement. Everyday bras are more concerned with the shaping and contouring of the breasts. All bra styles can be categorised into three construction categories, cut and sew, moulded, and seamless. All processes require detailed knowledge of precision measurements and material characteristics. The most common method seen in postoperative or specialised bras is cut and sew. Cut and sew involves careful measuring and drafting patterns in 2D, on paper or pattern-making software. These are then transferred to fabric, fitted to a model, and altered accordingly (Hardaker and Fozzard 312). Two methods of pattern making involve using “basic blocks” and taking personal measurements. Block pattern making involves manipulating a basic block. Often a company will have a set of these block patterns that form the basis of their clothing line. Block pattern making allows for varying styles without much measurement involved. These are often used in mass-produced garments. Personal measurements involve substituting the model’s own measurements in place of block measurements. This results in a more close-fitting garment, but is often more difficult as it can be challenging to recognise and make the alterations required for unfamiliar pattern outlines on actual body types (Haggar 4,5). A typical cut and sew bra consists of between twenty and forty-eight parts, including the bra band, cup, underwire, gore, straps and closure. The primary purposes of bra componentry are identified below and illustrated in Fig. 17 and 18. Covers and protects the nipples and shapes the breast. Holds the bra in place prior to fastening, they usually have elastic (picot) on either side to distribute the weight of the breast. The centre piece made from an elastic stabiliser fabric, to create cleavage. Provides ten to twenty percent of breast support. Provides the remaining breast support. Bra Cup Bra Wings The Gore (or Bridge or Centre Front) The Straps The Underband 2.3.1 PATTERN MAKING Fig 15. Practice-based devlopment to understand a typical cut-and-sew bra process following “Bare Essentials” guidelines. C O N TE X T R E V IE W C H A P TE R 0 2 B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 39 2.3.2 BRA DESIGN In the design of a bra pattern, it is also important to consider the frictional, gravitation and tension forces that will act on the bra and the body (Fig. 16) (Zhang 116). In particular, the materiality and shape of the shoulder straps and underband can directly affect the comfort and supportive forces of the bra. For instance, a thinner shoulder strap, while less visible, can cause the strap to dig in uncomfortably. Additionally, the tension of an elastic shoulder strap can cause the underband to displace from its comfortable position of balanced forces (115). Based on ergonomic design developments to improve bra fitting characteristics, the width of a shoulder strap should be between fifteen and twenty-three millimetres, and the underband rigidity should be increased to avoid displacement (121). For breast cancer patients, scar location also can influence the shape and materiality of a bra cup. Regular bra cups consist of two to three parts, with interconnecting horizontal and vertical seam lines to create structure, shape and silhouette (Matthews-Fairbanks 41). The materiality of these varies, from soft, stretchy materials to rigid and stiff materials. Unbalanced forces result in band riding up Balanced forces in horizontal level Fig 16. Forces acting on bra C O N TE X T R E V IE W C H A P TE R 0 2 Regular Bra Anatomy UnderwireHooks (back fasteners) Slider or ring (adjuster) Shoulder strap Bridge Side seam Wing Upper cup Eye (back fasteners) Apex (highest point of the cup) Lower cup Fig 17. Postoperative Bra Anatomy (Cut & Sew) Hooks or Zip (front fasteners) Slider (adjuster) Lower cup Eye or Zip (front fasteners) BackbandPocketed cup Wing Upper cupApex Fig 18. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 45 C O N TE X T R E V IE W C H A P TE R 0 2 Cut and sew methods can allow more technical manipulation of fabric as patterns can be designed for varying stretch characteristics that can allow better fit and provide different support requirements. A cut and sew postoperative bra of note is the Anita Lymph O Fit (Fig. 19), designed using a specialised uneven textured compression fabric to prevent and treat lymphedema, only for use after the scar tissue has fully healed. The areas where lymphedema is present (underarms and back) are targeted using this fabric, while the cup areas contain a softer lining. However, cut and sew methods have limitations for breast cancer patients as their construction can cause irritation to scar tissue and sensitive breasts (Gho et al. 780). Thus, it is essential to consider common scar locations following possible breast cancer removal surgeries (Fig. 20) to ensure seamlines are removed in these areas. Often in commercial bra design, standard sizing consists of a combination of a number and letter, with the number relating to the measurement of the underbust circumference and the letter referring to the difference between the bust and underbust circumference. It is commonly understood that the larger the letter, the bigger the cup size and the larger the number, the longer the underband length. However, bra cup sizes vary among styles and manufacturers (Bengtson and Glicksman 407), and many women lack an understanding of how these two numerical values relate. For instance, the concept of “sister sizing” determines that although a woman’s breast shape remains the same, the woman will be able to fit into various bra sizes due to the way cup volume adjusts with band size, making bra sizing even more complex. This complexity and lack of standardised cup sizes can often lead to confusion in the preoperative discussion between surgeon and patient, resulting in unmet expectations post-procedure, particularly in reconstructive surgery (405). Additionally, breast shapes and tissues are fluid, fluctuate throughout the hormonal cycle and are a continuous range of shapes, sizes and volumes, meaning that women often find it difficult to fit into standardised sizing (Wood et al. 6). Moreover, an individual’s breast shapes and tissues differ slightly, with one in four women reporting some degree of asymmetry between breasts (The Royal Children’s Hospital Melbourne). In an effort to reduce confusion surrounding bra sizes and simplify production, some manufacturers, such as New Zealand-based Videris are emphasising flexibility in fit, putting more emphasis on underband length over cup size and replacing the conventional numerical sizing with the Alpha Sizing of small, medium, large, etc, to combine multiple bra sizes into a single, more inclusive letter. This sort of sizing is more approachable for an online shopping experience, particularly when clearly explained how the sizing relates to measurement. A bra that offers flexible sizing could also increase appeal for breast cancer patients, who would otherwise need to purchase multiple different-sized bras to accommodate changes in swelling (Nicklaus et al. 3). To be able to offer a more flexible fit to a range of sizes, a postoperative bra should idealy offer adjustability through the stretch of materiality and changeable lengths of the shoulder straps and underband. As mentioned earlier, seamlessly knitted bras tend to have limitations in support. This is predominantly due to the designers’ and manufacturers’ lack of knowledge surrounding the relationships between 3D knitting, breast size, support, stitch structures, materials, and shape (Zheng et al. 124). However, seamless knitting offers the potential for a more efficient and sustainable alternative to cut and sew manufacturing (Gorea 33). Understanding the stretch characteristics and purposes of key parts of a functional cut and sew bra, alongside trends in scar tissue positions and medical requirements, can inform the development of a postoperative bra that utilises seamless knitting to reduce irritation to scar tissue and various knit structures to provide support, ventilation, tactile comfort, and antimicrobial wound care. 2.3.3 2.3.4 2.3.5 POSTOPERATIVE BRA SIZING SEAMLESS BRAS Segmental Lumpectomy Unilateral Mastectomy Modified Radical Mastectomy Reconstructive Surgery Fig 19. (Left) Anita Lymph O Fit Bra Fig 20. (Right) Diagrams of common scar tissue placements. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 47 C O N TE X T R E V IE W C H A P TE R 0 2 Computer-aided design (CAD) is becoming more significant in the pattern drafting process of lingerie design (Hardaker and Fozzard 321). The use of patternmaking programs allows for a faster workflow and more efficiency in the pattern grading and product development phases. However, most of these programs still represent a pattern as flat two-dimensional pieces that must be physically drafted before being sewn together to make a garment (Yick et al. 653). While three-dimensional CAD programs were already being used commonly in other areas of design, in 1997, Hardaker and Fozzard highlighted the difficulties associated with digitally modelling fabric accurately (321). Software developments, such as the Shima Seiki One Design (introduced 2007) System and Clo3D (introduced 2009), strive to readdress digital three-dimensional clothing design and significantly shorten a garment’s development timeframe. For example, Clo3D allows you to digitally draw directly on the body of a virtual mannequin (Fig. 21), generate pattern pieces automatically (Fig. 22), simulate different clothing textures (Fig. 23) and test their movement, all before physical construction. In this project, specialised software, such as Clo3D, can be used in combination with advancing technologies, such as 3D scanning, to allow garments to be modelled and tested on a variety of patient body shapes. A combination of these processes can determine the stretch rate required in the materiality (Han et al. 743) and how adjustable the garment and fasteners must be to accommodate the range of sizes needed for a flexible fit. 2.3.6 THE ROLE OF CAD Lingerie materiality choices have varied significantly over the years, with the use of woven natural fibres such as cotton, wool and silk in undergarments dating back almost 4000 years (Sena Cimilli Duru et al 7.). However, in the 1950s, synthetic fibres became a significant alternative to natural fibres, with fibres like nylon making undergarments easier to mass produce and more affordable and allowing for greater experimentation in design (Lynn 39). Currently, the clothing industry is predominantly dominated by synthetic, polymer-based materiality. The bra industry is no exception due to its reliance on the elastane and polyester fibres that allow bras to perform their elastic and supportive function. However, as wearers’ knowledge surrounding the health risks of wearing plastics for long periods close to the skin and the worry of growing microplastic pollution increases, manufacturers’ and wearers’ choice to use and wear synthetic fibres is reducing (Bruni 8). The key materials currently used in lingerie are cotton, synthetic silk, wool, polyester, and velvet (Lingerie Market). A postoperative bra’s unique healing and compression requirements mean that cotton and elastane blends are the standard choice, with elastane being somewhat relied on to provide the required strong and non-abrasive support to the breasts (Risius et al. 235). However, the limitations of synthetic materials include their inability to absorb moisture and break down. At the same time, while cotton is a breathable, natural fibre, holds dye well, is soft and offers absorbency, its growth has a highly negative environmental impact, and it is also susceptible to the development of organisms and the generation of particle dust, a cause of infection and irritant to scar healing (Rogina-Car et al. 636). TENCEL, a relatively new fibre extracted from sustainably grown wood, is beginning to be introduced into the medical market and offers properties that appeal to breast cancer patients’ healing and comfort requirements. Unlike cotton, TENCEL does not produce particle dust, has high absorption properties and offers antimicrobial and protection properties that could prevent infections (Rogina-Car et al. 642). As medical bras are often made from knitted fabrics, due to their ability to conform to different body shapes, the practical design exploration of this research will involve testing the knitting capabilities of 3D knitted TENCEL, elastane and mercerised cotton swatches. 2.3.7 MATERIALITY (From the top) Fig 21. Digital drawing on mannequin Fig 22. Generation of pattern pieces Fig 23. Simulation of clothing textures Fig 24. Tension tests 3D Knitted Bra Life Cycle (Fig. 26) Raw material extraction Yarn manufacturing Raw material extraction Bra manufacture + assemby Natural / Synthetic TENCEL / Recycled Lycra Spinning, bleaching, dyeing Chemical waste, green house gas emissions, transport between factories 3D Knitting and manufacture of componentry Cutting, sewing and assembly of 20-48 parts. Seperate manufacture of componentry. Offcuts, garment waste Bra manufacture + assemby Retail Use End of life Retail Use End of life Disposal landfill or incineration, possible reuse Disposal Seperation of componentry and knitted body (TENCEL certified as compostable and biodegradable) to recyce back into the system Conventional / Online Transport, air emissions and energy use Washing, drying, ironing Conventional / Online Washing, drying, ironing Transport, air emissions and energy use Traditional Bra Life Cycle (Fig. 25) Fabric manufacturing Yarn manufacturing Knitting / Weaving Spinning, bleaching, dyeing Chemical waste, green house gas emissions, transport between factories Water stress, energy demand Green house gas emissions, transport between factories Green house gas emissions Water stress, energy demand Water stress, green house gas emissions Water stress, green house gas emissions (Shaded circles are similar processes for both life cycles) B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 51 C H A P TE R 0 3 M E TH O D O LO G Y CHAPTER 03 Methodology In current clinical practice, getting patient insight into what they consider important in their treatment is becoming increasingly relevant. This practice is referred to as value-based health care, where “the value of care is the highest priority, and its quality is determined by the patients themselves” (Brands-Appeldoorn et al. 119). Following this ethos, this practice-based research applies an empathetic, user-centred, co-design process throughout that ensures all stakeholders are treated with dignity and respect, focusing on their emotional needs alongside the physical (Teisberg et al. 682). The initial phases of this research have provided a background understanding of the wearers’ and stakeholders’ physical and emotional needs in a postoperative bra. This background knowledge informs the development of design criteria to influence the design phase and validate chosen methods, materiality and technology choices. As bra wear success is highly dependent on its intended users, the product development process must connect back to their individual needs, following a human-centred methodology. Due to this, this project has full human ethics approval (Application 22/35, see appendix, page 175) to work closely with patients and experts. As a breast cancer diagnosis is a life-changing event encompassed by emotional and physical trauma, following a value-based healthcare approach ensures participants have agency and control over their participation. Wearable postoperative products fit within both a medical system, through supply from a hospital, and a commercial system, through purchasing with or without the surgeons’ recommendation (Sieradzki 18). Thus, it is essential to consider not only typical design development frameworks of concept generation, design and prototype development but also the scalability of the design, commercial viability and medical product production processes. To develop a commercial product, it must follow Good Manufacturing Practices or Design Control Procedures to ensure it is consistently safe to use, effective and meets its quality requirements. Key features of these practices include product validation which aligns with human-centred design practice and ensures the product meets the user’s needs and verification to ensure the product is developed using the correct procedures (Łącki et al. 639), which will be determined through physical testing and analysis. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 53 A human-centred design process focuses on understanding and responding to user needs through empathy and user research, often involving only one-off and short-term engagements with users. This process gives the designer the most agency, as they have the most knowledge surrounding the different influences within the product development (e.g. the feasibility, desirability and viability of the product). However, the downfalls of this process are that user needs can be generalised or misunderstood through these short interactions (Kulyk et al. 45). Due to these limitations, this process is predominately drawn on only at the onset of this project through the collection of quantitative data to inform early concept generation and verification of design outputs. In comparison, a co-design process emphasises building relationships with all stakeholders by ensuring they have collaborative, active participation and involvement in the design process. Many resources focusing on improving wearable products for breast cancer patients recommend using a co-design process with groups of patients, medical professionals and designers to surpass the assumptions based on one- off patient suggestions and complaints (LaBat et al. 317; Adler et al. 1; Gorea). Thus, this process is trialled through this research at multiple stages, including the design review, body scanning and wear testing stages, to encourage a responsive analysis and development process. Additionally, this co-design process can also be drawn on in the testing and analysis of materials and technologies. This allows us to respond to these experimentations, also giving them and their possible capabilities agency and influence on the product’s development. For instance, an iterative, co-design process with 3D knitting technology and the knitted textile ensures the design can be continuously developed alongside testing the technology’s potential rather than manipulating the technology to replicate the design. Following this methodology throughout this research confirms that value is placed on the design process itself, not only the outcome. This research employs a multi-stage data collection process to collect both quantitative and qualitative data, known as “mixed-methods research.” This form of data collection is highly valued in product design and is used to “expand and strengthen” conclusions as well as ensure validity throughout the design process (Schoonenboom and Johnson 110). The selection criteria for primary participants are participants who have lived breast cancer experiences, are still relatively active in support groups and feel comfortable talking about their experiences. These participants are recruited through advertisements shared by organisations such as Breast Cancer Foundation NZ and the Cancer Society, as well as surveys shared in online cancer support groups with approval from the administrators. To collect and correlate quantitative data, the anonymous survey has the largest participant pool, with over a hundred respondents, to assess product satisfaction in this area. Sixty-three of these respondents left contact details to be further involved with the research. To better reflect the human experience and begin building relationships with participants, semi-structured interviews and design reviews are carried out with fifteen of the participants who requested further involvement. These participants were chosen based on their in-depth survey responses and dissatisfaction with existing products and locations based in New Zealand. For 3D scanning, a limitation of the study is participant location, as the technology is based in Wellington at the College of Creative Arts, Massey University. Thus, within the interview stage, it is important to narrow down the participant pool to participants based within the Greater Wellington Region. Due to time constraints in this Masters, only two participants have been chosen for body measurements and user testing to ensure product validation from various perspectives on different body shapes. 3.1 3.3 3.2 3.4 DESIGN PROCESS PRIMARY PARTICIPANT SELECTION ETHICS & EMPATHY SECONDARY SOURCE SELECTION To minimise harm to participants, this research follows the Massey Human Ethics (MUHEC) principles to ensure participants have autonomy and agency throughout all the stages of their involvement. Participants who have lived breast cancer experiences are recruited through advertisements and informed that participation has no connection to their existing treatment. Within the survey and advertisement, there is space for the participant to reach out directly to the researcher or leave contact details to discuss their experience further. To avoid physical and psychological harm, participants are made aware from the start of the research process through consent forms and information sheets that they should only provide information where they feel comfortable (see appendix, page 176). They are also informed that they can withdraw from the study at any point and are supplied with free consultation numbers from Cancer Society NZ and Massey Cancer Psychological Service to be used in the event of distress. Additionally, the research methods chosen aim to reduce discomfort as much as possible. For example, surveys and interviews are conducted digitally, giving participants a choice of times and locations that best suit them. Non-contact body scanning is the primary method used to obtain body measurements as it minimises physical touch and allows for a large quantity of measuring data to be collected in a single scan. The values of whanaungatanga and manaakitanga underpin this research project and are drawn on throughout to ensure the participants and their values are empowered and uplifted. To ensure confidentiality for vulnerable participants, they are referred to through the use of pseudonyms, the data obtained is protected by passwords, and any imaging data is obscured and unrelatable to the participant. As this product development fits within a medical system, it is imperative to also engage secondary sources in this research. These consist of experts (lymphedema therapists, breast fitting specialists, oncology surgeons) who have knowledge of breast cancer procedures, their side effects and requirements in aftercare. These experts are identified through online searches, word of mouth, and patient referrals, where primary participants have suggested that they be contacted as part of this research. One person from each of these areas of expertise will be drawn on to provide feedback on the development of the design, review the potential care it provides and offer invaluable insights to stimulate the design process through semi-structured interviews and design reviews. Additionally, existing products within this area often require surgeon endorsement to be commercially available to patients, so designing with all stakeholders ensures a product is designed that will best meet all the user’s needs. C H A P TE R 0 3 M E TH O D O LO G Y B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 55 User research Project aims Concept design directions User interaction: Questionnaire Concept evaluation and testing User interaction: Interviews Body scanning Build and prototype User interaction: User testing Final evaluation Ethical approval Commercialisation project planning Responsive design Methodology: Design Process Fig 27. CHAPTER 04 Methods B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 59 Surveys or questionaries are a standard method in health and sciences research to understand trends that can be quantified and analysed. The questionnaire (see appendix, page 180) combines multi-choice, check- box answers (with image prompts) and open-ended questions to collect quantitative and qualitative data, reinforce the study’s aim and make the questions easy to respond to. The questionnaire is split into key themes; within each, the questions move from broad focus to specific content to enhance acceptability (Schofield and Forrester-Knauss 11). Each theme contains questions to understand the participants’ existing knowledge, subjective attitudes and values to identify design challenges (13). The themes consist of; Procedure Background, to collate patients’ experiences with their surgical procedure; About Your Bra, to identify the fitting trends and influential factors in bra choice, regardless of their operative experience; Bra & Health, to understand what is lacking in their existing postoperative bras; and Bra & Prosthetic, to determine what influences the choice of wearing a prosthetic. This questionnaire also allows participants to leave additional comments or contact details if they want to discuss their experiences further. Following the interview and initial relationship building, body scanning is the primary measuring technique to obtain the data surrounding the patient’s variance in breast forms and shapes. However, manual measurements can also be recorded if the patient is uncomfortable with this technology. The researcher conducts two upper torso scans of a patient in a private space; the first collects imaging data of the patient wearing their favourite bra, and the second is in the nude state to reflect the actual size and shape of the individual breasts. Comparing these scans illustrates how a well-fitting bra can alter the shape of the natural breast form and identify a participant’s desired breast shape. Then, using Clo3D, the design developed can be digitally worn by the patients to ensure the correct fit before manufacturing physical prototypes. 4.1 4.3 4.2 4.4 DIGITAL QUESTIONNAIRE BODY SCANNING INTERVIEW + DESIGN REVIEW USER TESTING Secondly, semi-structured interviews and discussions between the researcher and patient are used to expand on survey responses, build narratives of experiences and demonstrate the usage of existing products or solutions. Semi-structured interviews have been chosen as they are an effective method to explore participants’ emotive responses and target the discussion to particular themes. They are also commonly used to acquire qualitative data sources in health sciences research (DeJonckheere and Vaughn 1). This stage will also involve a design review (see appendix, page 187) where the patient, expert and designer will evaluate initial designs and features in response to research aim two, ensuring a co-design process. As a postoperative bra has to be worn directly on the skin for long periods, wear testing is an essential part of this product development and is used in this research to ensure product validation from various perspectives on different body shapes. After testing the design on a patient’s digital form to ensure the correct fitting properties, a prototype can be manufactured. The patient is then asked to wear the bra and evaluate its wear and fit characteristics (shape, support, comfort, ease of use and aesthetics) on a five-point Likert scale (Zhang 143). This evaluation will be drawn on in the discussion of the successes and limitations of the final postoperative bra prototypes. C H A P TE R 0 4 M E TH O D S B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n IN TR O D U C TI O N C H A P TE R X X 61 Methods Digital Questionnaire Idea Generation 104 patients Interviews Exploration 15 patients Primary Users Secondary Users Interviews Exploration 5 Experts Design Review Evaluation 15 patients Body Scanning Exploration 5 patients User Testing Evaluation 2 patients Design Review Evaluation 3 Experts Quantitative Method / Function Qualitative Method / Experience Secondary ResearchPrimary Research Context review / content analysis Anecdotal (narrative) analysis e.g. After the Cure Case studies Market analysis Product dissection Questionnaire Design review Interviews Small scale user testing Scientific studies Randomised Controlled Trials Body scanning Fig 29. Bi-polar chart linking methods used to methodology Fig 28. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 63 C H A P TE R 0 5 R E S U LT S CHAPTER 05 Results One hundred and four participant responses to the survey have been recorded. Within this group, forty- seven percent reported having a unilateral mastectomy, thirty-seven percent reported a bilateral mastectomy, and fifteen percent reported having breast-conserving surgery or a lumpectomy. In total, sixteen percent of this group had some form of reconstruction (five respondents specified implant reconstruction and six specified trans flap reconstruction), and thirty- five percent had some form of lymph node (axillary) removal. The timelines of when these procedures occurred ranged from 1998 to twelve days ago, with three years ago being the average timeframe. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 65 This section of the survey aimed to gain knowledge about areas of discomfort, recovery times and struggles. The most predominant physical discomfort recorded was the breast that was operated on (forty-seven percent of respondents), followed by the armpit and underarm (twenty percent). The shoulder, torso, lower back and upper back discomfort were also briefly mentioned. Recovery times varied drastically; the minimum recovery time is reported at “about a week” for a mastectomy procedure, with the maximum being “seven years” for a lumpectomy followed by additional treatment. The average timeframe is around ten weeks to three months for a range of procedures, with ten respondents reporting that their recovery is still ongoing. This signifies that recovery times are less dependent on procedures but more on the individual’s response to trauma and that the design of a postoperative bra must reflect this variance in use, borrowing aesthetic qualities from regular long-term bras alongside the functional needs post-surgery. Twenty-six percent of the respondents’ overarching areas of struggle were orientated around finding a suitable, comfortable bra or one that fits correctly. Other responses were based on themes of nerve pain and discomfort (31 responses), lack of mobility (14 responses), scar tissue chording (5 responses) and accommodating changes in swelling (11 responses). While not all these struggles are directly related to bra use, they are all themes that should be accommodated for in wearable product design. Here, check-box answers and open-ended questions began to focus the survey on existing postoperative bra wear experiences, focusing on likes and dislikes and styles and duration of wear. Twenty-five percent of participants disclosed that they didn’t wear a postoperative bra after surgery at all. The reasons for this included being unable to get a “one- boobed bra,” a lack of knowledge” and “not knowing [bras] were available,” being unable to find flexible options to accommodate swelling and wearing one being too painful. The remaining participants discussed their experiences, with thirty percent still wearing postoperative styles eleven weeks to seven years after surgery. In open- ended statements, participants expressed negative and positive features of the bras they wore. Positive comments related predominantly to the ease of front opening (19%), comfortable materiality (25%) and the medical benefits the bra provides (10%). The negative responses included the lack of adjustability and support (20%), unreliable, difficult-to-use fasteners (13%), and limitation of choice (13%). 5.1 5.3 5.2 5.4 PROCEDURE BACKGROUND BRA & HEALTHABOUT YOUR BRA BRA & PROSTHETIC This section asked respondents to comment on the factors important to them in a bra and how they choose and access their bras. As previously assumed, comfort ranked highest for ninety-six percent of participants, followed by fit quality (77%) and support (75%). Additionally, when asked what bra size participants wear, a significant number of them seemed unsure, with 31 respondents offering a variation in size or saying they have “no idea now”, reinforcing the importance of a flexible sizing system to increase the approachability of a postoperative bra. Fig. 30 strengthens this further, with forty-eight percent of participants not believing their bra fits them correctly. Twenty-two percent of respondents reported wearing a prosthetic. The remaining patients do not need one or reported it being too hot and uncomfortable to wear daily. The main reasons for wearing a prosthetic were to increase the symmetry of the chest (77%) and to fit clothing better (68%). Unfortunately, responses also included “I was told to” as a reason for prosthetic use, reinforcing the harmful discourse that positions the postsurgical body as incomplete. It is essential to note that some statements contradict each other. For instance, some patients request an “asymmetrical” shape, while others want to hide their breast shape difference; some want more “feminine and youthful” colour options, while others state that they “didn’t care about colour at that time.” Additionally, some respondents request “lace” and a “sexy” bra, while most are more concerned with “antimicrobial, natural, breathable” fabrics. Finally, a few respondents also mentioned wanting “wider shoulder straps,” while others complained about their thickness in existing bras. These contradictions highlight that although existing products in this area employ very similar styles, there is no one-size-fits-all solution; patients require more adjustability and choice in their postoperative wear. The insights gained from the survey offer guidance towards initial concept generations. In particular, the open-ended explanatory statements generate a deeper understanding of a patient’s journey and experiences and provide the framework necessary for further in-depth interviews, design matrices and reviews. Do you think your bra fits you correctly? Yes No Are you content with existing bra options available? NoYes Is your bra comfortable? Yes No C H A P TE R 0 5 R E S U LT S Fig 30. Fig 31. Fig 32. You’ve lost your femininity because you’ve lost a breast, and then they want to put you in these God- awful contraptions. I’m at that stage where I’m frustrated and have sort of " stopped looking. I always have one breast a different size to the other, which makes fitting very hard – " very tight on one side or loose on the other. Gho et al. 7 I’ve looked overseas because of the absolute lack of any nice bras. I’ve tried lots of places, but there’s nothing. Seriously. " There is absolutely nothing. CHAPTER 06 Concept Developments The design developments in this chapter are split into key themes: Section I: 3D Knit Developments, Section II: Fastening Systems, Section III: Increased Customisation and Section IV: Wearable Technology. These themes will allow design concepts to be developed, focusing on key problems identified in earlier research. However, aspects from each section interlink and integrate to design and develop a postoperative bra that meets the patient’s needs. The results of this section are interpreted in accordance with Research Aim 2: To analyse breast cancer patients’ perception of bra comfort, through a selection of designs, orientations, and material choices. It will discuss and evaluate the design developments through a co-design review with participants to analyse their needs. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 73 C H A P TE R 0 6 C O N C E P T D E V E LO P M E N TS CRITERIA COMMENTS MATERIALITY SHAPE AESTHETIC 01 All components must be easily washable. 02 The bra should be able to manage heightened skin sensitivity. 03 Material choices and structures should consider thermal comfort. 01 The material should dry 30-60 minutes after being sprayed with 2.25g of salt solution at 210 o C 01 Customisation/variance in colour should be possible. 02 The bra should have aesthetic longevity. 01 Aesthetics can contribute to an improved body image. 02 The bra should borrow aesthetic qualities from regular bras to reflect long-term use. 01 Sizing must accommodate asymmetrical breasts. 02 Must be adjustable for weight and swelling fluctuations. 01 The ability to interchange cup sizes or adjust each cup size is required as presently asymmetrical breasts are not usually accounted for in bra design. 02 Women will experience fluctuations in fluid retention around the axillary and torso area. (Gho et al. 783) Design Criteria USABILITY COMFORT MEDICAL REQUIREMENTS 01 Must be able to be done up with reduced ROM. 02 Fasteners are reliable. 03 Bra componentry should be minimal. 04 Sizing should be easy to understand. 01 All fasteners required to don/ doff the bra are accessible on the front of the body. 02 Fasteners stay fastened while the bra is in use. Fastener must remain fastened with a tension of 825-1000 g/cm^2. 01 Straps must not dig in. 02 Must be comfortable to sleep in. 03 The bra must provide tactile comfort. 01 The width of should strap should be between 15—23 mm. The strap needs to be adjustable. Strap placements should avoid areas of sensitive tissue. 02 No fasteners on the back. 03 No hard components should directly touch the skin. 01 Bra accommodates a breast prosthetic. 02 The material must not damage the skin. 03 Must provide lymphatic compression. 01 Bra accommodates a breast prosthetic. 02 No seamlines in areas where scar tissue may be present. No harmful dyes/dyes should not leach colour – the water should be clear after the material is submerged for 24 hours. See appendix for a detailed Design Matrix (page 186) Fig 33. B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 75 C H A P TE R 0 6 SECTION I. 3D Knit Developments This section will focus on developing 3D knit structures and forms to manage heightened skin sensitivity, provide support and ensure thermal comfort (Gho et al. 784). It documents the practical testing and evaluation of 3D knit as the primary manufacturing technology in this project, utilising an iterative design process where specialised CAD software is synthesised with physical testing to streamline development. Moving between design spaces allows the knit technology to be fully applied in order to create a highly technical wearable garment (Fig. 34). Fig 34. Synthesis between design spaces DIGITAL DESIGN PHYSICAL DESIGN TEST & EVALUATION CONCEPT GENERATION 3D Scanning Clo3D 3D Knitting 3D Printing User research Context review Questionnaire Wearable Technology Cut & sew 3D Knitting 3D Printing 3D Scanning Design review Wear testing C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 77 Different stitch structures were programmed and knitted for testing to better understand the possible capabilities and the parameters of 3D knit. The structures were designed on the SDS One Apex software on identical 200mm x 200 mm bases to develop an understanding of the relationship between digital simulation and physical output. The initial experiments (Fig. 36) were knitted using the SES-S.WG (Whole Garment) machine and consisted of 100% mercerised cotton yarn, 100% TENCEL yarn and a combination of these yarns with elastane. All the following shaping iterations were knitted using a SIG 123SV intarsia knitting machine with a 14 gauge (Fig. 35) to allow for differing yarns to be seamlessly integrated within one textile form. 6.1.1 KNIT STITCH STRUCTURE EXPERIMENTS These initial structure experiments consist of directional ribs, meshes, tucks, links and misses. Ribs are the structure of choice for the bra cup. Vertical ribs have great corresponding horizontal stretch, which can potentially be used in varying directions to create a four-dimensional stretch providing shaping and adjustability in this area without using seam lines. Meshes can be used to generate breathability in specific areas which require thermal regulation. A tuck stitch is formed when a needle, already holding a loop, receives a further loop; this reduces vertical stretch but increases horizontal width, potentially making it suitable for a back band with high horizontal elasticity. The link stitch creates a lattice texture, increasing stability and allowing it to be used for the side band to increase structural compression. Fig 35. SIG123SV knitting machine Plain Knit Mesh Directional Rib Directional Rib Directional Rib Tuck Link Link C H A P TE R 0 6 Fig 36. Knit structure experiments C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 79 Visualisation of Knit Structure Placement Mesh To increase breathability and structural stability in the centre front area. Directional Rib To increase the stretch in the cup area and accommodate for fluctuations in breast size. Mesh To increase breathability and stretch in the backband area. Link To increase stability and provide structural compression in the axillary lymphatic area. C H A P TE R 0 6 Fig 37. C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 81 Fig 38. Knit swatch sampling C H A P TE R 0 6 C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 83 Unlike pre-existing uses for knitting machines, which only allow designers to alter templates, this research aims to push the boundaries of technical 3D knitwear, creating a pattern from first principles and incorporating different structures to build form. This process requires increased iterations and a more significant understanding of the program as each stitch has to be drawn free-hand. Regardless of construction methods, it is evident that shaping and form are an important part of the design of a bra. This shaping is increased with the usage of picot elastic, which frames the entire border of the bra and is stretched 20% of its original length when sewn to build form. However, this additive construction method could increase irritation to sensitive skin. 3D knit technology allows the creation of various fields, telling the machine to knit a different colour or yarn in those areas. For example, bordering a knit with an elastane ‘field’ (Fig. 39) could seamlessly replicate the purpose of picot elastic, thereby shaping the edges of the bra. Targeting elastane to specific places like this, instead of incorporating it throughout the whole bra, also reduces the total elastane quantity. Minimising elastane lends itself to a more sustainable product, a quality that corresponds with the emerging paradigm shift of moving away from a plastic-based lingerie industry. 6.1.2 KNITTING A 3D FORM Designing a bra in Clo3D allows the pattern to be exported in separate pieces; these then have to be merged together before importing the full bra shape into the 3D knit program. Structures can then be drawn within the program and visualised before knitting. Knitting rectangular swatches of these individual structures before combining them ensures the correct stitch size, speed and take down are prepared in advance. In the iterations that follow (Fig. 41), errors such as laddering, bunching and incorrect physical size are expected. These errors can be rectified by checking for broken needles, simplifying complex shapes, and changing yarn tensions and stitch sizes. Fig 39. Framing the bra with an elastane ‘field’ Fig 40. Programming iterations C H A P TE R 0 6 C O N C E P T D E V E LO P M E N TS 85 01 Cut & sew development using knit structure swatches. 02 First iteration of shaping using imported pattern file from Clo3D. 03 Combining structure and shaping with elastane field. Perpendicular ribbing to increase the stretch in the cup area caused the cup to look stretched. 3D Form Developments Fig 41. 04 Testing a different bra design with various structures. 05 Interlock structure in the back (simultaneous top and bottom bed knit) caused strange shaping. Took out vertical elastane under the cup to reduce mesh bunching. 06 Introducing chevron ribbing in the cup to build a rounder form. Back shaping was improved with the use of elastane framing to reduce gaping. Reintroducing vertical elastane under the cup to increase support for the breast. 07 Centring the position of the chevron rib. Adding ribbing to elastane edges to reduce their rolling. Adding mesh cording to the back to increase breathability. Increasing the distance between mesh holes to tighten the structure and reduce bunching. 08 Reducing the lines of mesh cording at the back. Experimentation with TENCEL/ elastane combination on the edging. 09 Increasing the width of the tubular waistband. Mirroring design to create a full bra. 10 Trialling different strap structures - framing with elastane and full TENCEL to test strap stability. 11 Acknowledging the limitations of the knitting machine used for prototyping (unable to knit integrated pockets for prosthetics alongside functional structures) and developing a seamless lining to attach to the edging of the bra. 87 SECTION II. Fastening Systems As seen in the context review, user experience is a large area that encompasses the entire bra’s usage, from the understandability of the bra sizing to the ability to don a bra independently and the comfort the bra provides during use. This section will document the development of bra fastening systems that allows for increased ease of use and scalability in manufacturing. It will explore styles that allow the user to maintain control over the functionality and style of the bra to restore body image and self-confidence. Fig 42. Fastener Iterations B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 91 Fasteners, their placement, their method of fastening (continuous, interval or no adjustability), and the type of fastener were discussed during the design review. Fasteners are a key part of the bra experience. However, participants have voiced difficulties with hooks and eyes and “zips failing.” Creating a new form of fastener that is intuitive to use, able to locate and adjust easily and not abrasive to the skin is a key challenge in this project. In particular, creating a fastening component that can lock together and adjust as one unit often resulted in quite a bulky design (Fig. 43). Borrowing attributes from existing generic bra fasteners, such as separate sliders for adjustment, is a way to reduce the size of the fastening component to only perform a locating and clasp function without limiting adjustability. Additionally, the approachability of magnetic componentry in fasteners was explored through the design review, with the overarching conclusion that as long as the fastener holds together, there is no issue using a magnet as a locating feature. Slight concerns were mentioned surrounding strong magnets being attracted to metal ports in chest expanders, setting off security alarms in airports and positioning near a pacemaker. Various Neodymium Disc Magnets (12mm x 1.5mm, 10mm x 1.5mm, 6mm x 1mm) with respective pull forces, 1.08kg, 0.86kg and 0.3kg, have been trialled, with initial designs relying solely on magnetic strength (Fig. 44.1). While this design located easily, any sliding force caused it to come undone. The combination of a magnet with a hook to stop sliding movement means that the only purpose of the magnet is a locating feature before locking with the hook. Thus, the size of the fastener can be reduced further to accommodate the smallest magnet. 6.2.1 FASTENERS PLACEMENT Initially, three varieties of components needed for the bra were developed simultaneously: waistband fasteners, shoulder fasteners and sliders (Fig. 44). The waistband fasteners initially differed from the shoulder fasteners as they required a larger surface area to connect to the stretchy waistband (around 40mm wide). However, this more significant surface area reduced their ability to conform to the body’s natural curves. The different connection mechanisms also decreased understandability for the user. Thus only two component varieties, the fastener and the slider, were developed further. Typical sliders are often made from powder-coated metal and range from 8-22mm in width. However, their small edges make them problematic to adjust. Therefore, forms have been explored that include flat protruding edges to increase their usability (Fig. 44.2). These components have been tested to ensure they are reliable; able to remain fastened with a tension of 825-1000 g/cm2 (Zhang 129), are not abrasive; do not sit directly on the skin with no sharp edges and can sit on the body comfortably due to their small size. When asked about fastener placement, respondents suggested that centre-front fasteners (the most commonly seen in existing postoperative bra placement) are understandably the most approachable. While moving fasteners from the centre to around the torso can provide increased support and adjustability, it is important to keep these as near to the centre front as possible to ensure easy access. Fig 43. Fastener ideation C H A P TE R 0 6 C O N C E P T D E V E LO P M E N TS Shoulder fasteners Sliders (strap adjusters) Waistband fasteners Fig 44.1. Fig 44.2. 93 A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n B re as t C an ce r R eh ab ili ta tio n C H A P TE R 0 6 Fig 44. Fastener development C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 95 C H A P TE R 0 6 Fig 45. Design developments C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 97 When designing for increased independence, it is essential to draw on the range of motion typical for the user group (no reach behind the back or above the head), which in this case means all methods of closure are required to be on the front side of the body. Several fastening configurations have been trialled, including extendable backs that can be tightened from the front of the bra once on the body (Fig. 46 & Fig. 47). This configuration would allow the bra to be shrugged on without raising the arms higher than 30 degrees. However, it results in extra materials on the back that need to be bunched once donned, reducing comfort during sleep when lying on your back. Other directions include; giving the wearers the ability to configure the bra before donning it and then adjusting the fit from the front (Fig. 50). Also, stabilisers (or beards) to hold shoulder straps in place during donning (Fig. 48) and continuous straps to focus adjustment areas to specific, easy-to- reach areas (Fig. 49). The fuller coverage form and higher “racer-back” cross-over strap in this concept is reminiscent as “more of a sports bra” and thus appeals to larger- breasted participants. However, some participants mentioned that the cross-over may be too high and could be difficult to get into or cut into the underarm area. Feedback from design reviews (Bra Concept 1 and Bra Concept 2) reinforces the importance of adjustability in shoulder straps. The ability to configure the straps to various styles, including halter, cross-over, and straight, means less pressure is put on one shoulder area, and the bra can be worn with more clothing options. Some participants also mentioned the possibility of providing interchangeable straps; a wider one for comfort around the home, and a thinner one for being in public, would appeal highly to them. These findings reinforce the assumption that increased user control of style and fit results in a higher positive emotional connection and, therefore, increased bra use. In response to this feedback, further developments will focus on styles that allow for interchangeable shoulder strap configurations. 6.2.2 DONNING & DOFFING C H A P TE R 0 6 Fig 46. Extendable Back Design 1 Fig 47. Extendable Back Design 2 Fig 48. Strap Stabiliser C O N C E P T D E V E LO P M E N TS B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 99 Front facing torso fasteners Fastener to adjust strap length from front of the bodyKnitted mesh for breathability Continuous strap to distribute support across body Integrated pockets for lymph compression panels Fig 49. Bra Concept 1 Adjustable bra straps - halter | cross over | straight Backband that can adjust compression prior to donning the bra Torso fasteners to adjust fit and compression levels during wear Slider to adjust strap length from front of the body Integrated pockets for lymph compression panels Fig 50. Bra Concept 2 C H A P TE R 0 6 C O N C E P T D E V E LO P M E N TS SECTION III. Increased Customisation “Going flat” is an emerging trend after a breast cancer procedure, as more patients choose to opt out of elective, additional, reconstructive surgeries, with only twenty percent of patients who have a breast removed choosing reconstruction (Crompvoets 138). Patients who “go flat” often have extra skin or fat tissue and more chest concavity. Traditionally, these patients would be then required to forego wearing a bra or be forced to wear a prosthetic in their bra at all times as the regular shaping structures of a bra cup would result in gaping and an uncomfortable fit. A high number of participants surveyed and interviewed disclosed, at the minimum, the variance of a full cup size between breasts. Additionally, they mentioned the struggles of sourcing different bras throughout the recovery stages, describing full cup size changes as swelling subsides. Bra manufacturers such as AnoOno, and TomBoyX are taking steps to accommodate these needs and provide bras for unilateral support. The downfalls of these bras are their limited adjustability, with some only offering unilateral coverage, leaving the operated breast bare and others asking for a single, approximate cup size, which may be difficult if there is a significant variance between the breasts. Thus, this section will focus on conceptual developments that allow for interchangeable or adjustable cup sizes in bra design (Gho et al. 780). B re as t C an ce r R eh ab ili ta tio n A h ol is tic a p p ro ac h to w ea ra b le p ro d uc t d es ig n 103Fig 51. Previous research has identified a cross-over shape as a way to allow the wearer to “control each cup size independently and accommodate both sides of the body without requiring a prosthetic for adequate fit” (Grunfeld 32). When evaluated by representatives at Farmers Lingerie Department, this cross-over shape was seen as a way to reduce damage during donning, even for “regular bras”. However, the physical prototype (Fig. 11) had a great deal of room for improvement. Assessment against initial design criteria revealed that the shape and form of this bra could be improved, as it was very flat and tended to gape around the chest area. Initially, design directions focused on continuous straps that could be adjusted from set places on the body to tighten individual cup sizes (Fig. 51). This direction allowed for separating the bra’s construction into specific zones to incorporate different fibres and structures for particular needs (e.g. compression, breathability). However, issues with this development included increased pressure placed on scar tissue areas through strap tubing and an inability to fully fasten the bra from the front, making it difficult for the wearer to don and doff. Conversations with knit & contoured apparel expert, Nina Weaver, identified issues with sizing and shaping in cup sizes with dramatic differences. Consequently, explorations into increasing customisability from a wearer’s perspective followed. These conversations led to explorations into modular bras, two cup sizes that are fitted and sized separately and can be worn together. Initially