Designing Care(fully) – Individualized Breast-Support Clothing in the Context of Breast Cancer

Gloria Aino Grzywatz: At the beginning of your career, you called yourself a fashion designer, and then came a turning point and you transitioned to the term clothing designer. What triggered this switch?

Silke Hofmann: I’ve been involved with clothing and have sewn my own clothes since I was a teenager. Back then, it was a kind of protest against the clothes you could buy. I used textiles which evoked certain feelings in me, such as my mother’s batik dresses from the 1970s, in order to feel closer to her as a person in this period of her life. »How is clothing experienced?«. Musing on this question has always been a personal interest of mine.

As an adult, I worked as a fashion designer in the clothing industry for many years until a friend approached me after experiencing breast cancer and told me that she felt very discomforted, more so than she had felt during her breast cancer treatment. What made her feel so uncomfortable was the range of clothing offered to her by the clothing industry now that she had re-entered everyday life. On the one hand, I found this shocking, yet, on the other, fascinating. I then decided to address this topic.

Since then, the variety in the range of available breast-support garments for people affected by breast cancer has improved. However, gaps in the provision of garments and in the perception of the needs of those affected still exist and have become the focus of my research.

Gloria: Is it easy to find your own terminology?

Silke: No, definitely not. However, for me it was a matter of necessity because I find the term »fashion« as a descriptor for the design and development of clothing quite problematic. »Fashions« and »trends« exist across all the design disciplines, and I fail to understand why clothing design, in particular, is called »fashion design«. This is a flaw in the system, and this also applies to the way in which we currently »consume« clothing, namely in very unfavorable cycles and contexts. The term »breast-support clothing« has also developed over a number of years. My reason for finding reduced, factual descriptions is to create interpretative freedom that also opens up possibilities for new design deliberations. The term »bra«, for example, implies a particular garment, whereas the term »breast-support clothing« is not associated with a specific garment construction principle, but only describes the basic function of a garment.

Gloria: I assume that part of this conceptualization is also the close collaboration with those affected in order to establish their specific needs?

Silke: Yes, absolutely. I have developed a design method for this, which I call the Participatory Clothing Design Session. People affected by breast cancer use it to develop prototypes in order to recognize, articulate and classify their clothing needs – especially with regard to breast-support clothing. I have noticed that not only are very specific clothing needs identified, but that stories are told during the discussion of clothing needs that explain how these needs arose. The initial context of (pure) information gathering suddenly became one of communal cooperation and exchange. Learning about our own bodies together was very moving.

Gloria: I think that is an extremely important aspect. To have the space to learn about your own body through clothing and fabrics, but also to be together as a community. How strongly do you think this aspect is generally championed in the clothing industry?

Silke: In the design process, the expert knowledge of the wearing experience is usually not attributed to the person who actually wears the garment, but to the designer. I therefore think that it is important to reverse expert knowledge in these contexts. Above all, I believe that it is necessary to integrate wearing experiences within clothing industry design processes. My reading of the Anti_Fashion Manifesto by trend forecaster Lidewij Edelkoort, which she published in 2015 and in which she states that consumers will deal with clothing differently in the future and become aware of their expert knowledge about their own clothing and design needs, also confirmed this.

»The consumers of today and tomorrow are going to choose for themselves, creating and designing their own wardrobes… Therefore, trend forecasting will change as well, taking its leads from social change and finding creative ideas within lifestyle trends and consumer behavior. Focusing on textiles and colors in favor of anecdotes. Analyzing clothes from an anthropological point of view.«¹

Gloria: What came after the Participatory Clothing Design Session?

Silke: The next step in the research process came about as a result of three major research grants, each of which was linked to a product design assignment. I named the resulting iterative product developments embrace and numbered the individual development steps: embrace1, embrace2 and embrace3. The term »embrace«, as a verb, is inspired by Alber Elbaz, who had a very gentle way of designing female clothing and who described his feeling during the design process as follows:

»For years, I felt I was hugging people with my clothes. I thought that every dress I make will be hugging the woman that is wearing it.«²

In general, I consider the bra as a singular, breast-support construction a solution unable to do justice to the diverse, natural processes of change to which the female breast is subject during a person’s life cycle. Specifically, the range of bras offered to people affected by breast cancer is also particularly inadequate.

Through a modular design approach, I attempted to discover how to meet the largest possible number of needs that were communicated in the Participatory Clothing Design Sessions, which led me to additive manufacturing processes such as engineered knit. Because the knitting production process is programmable and can be automated, individually selectable variations of a modular garment can be knitted. Additive manufacturing processes are forward-looking for the clothing industry, not least in terms of conserving resources, as only the textile material that is actually needed is used.

When developing the prototypes, it was also important to me that the technologies and processes I work with are scalable and can be fed back into the processes of the clothing industry. embrace should not be a one-off production, but should open up the realistic possibility of mass customization.³

Gloria: How difficult do you think it is to introduce a product like this into an industrial cycle?

Silke: I don’t believe that it would be particularly difficult. However, when I talk to people in the industry, i.e. experts, they often assume that the group of consumers affected by breast cancer is too small to be relevant to the market. I find this view interesting, because breast cancer affects one in eight people with female breasts worldwide, and the trend is rising. That is currently almost 13 percent i.e. a considerable percentage of the female population.⁴ Many of these individuals will live with differently sized breasts, one breast or no breasts for the rest of their lives after their breast cancer treatments, and that without wanting or being able to have their breasts reconstructed or to wear breast prostheses every day. Hardly any breast-support clothing on the market exists for their specific circumstances, and so their bodies are not normalized and are largely invisible in a social context.

Gloria: Both in art and in everyday life, the body continues to be strongly »idealized«. Bodies are often depicted in a way that does not correspond to the natural. We grow, we get older, our bodies change, our bodies are neither static nor will they ever be. That’s why we need clothes that work for us and not against us, because what clothes can definitely do is make us feel good in our own bodies, helping us to perceive them as positive and thus free ourselves, to a certain extent, from supposedly predetermined norms.

Silke: People often think »there’s something wrong with my body« when their clothes don’t fit properly. I find the experience of wearing well-fitting clothes, when this was not previously the case due to incorrectly standardized clothing sizes and fits, extremely important and self-empowering. In my research I am particularly interested in exploring how feeling comfortable in one’s own body is impacted by wearing clothes.⁵

In addition to being mass customizable, engineered knit also offers the possibility of making clothing sizes more fluid thanks to the programmable, additive manufacturing process and the natural elasticity of the technical knit construction. To take advantage of this adaptability and suppleness of the knit and in order to provide additional support for differently sized breasts or a single breast, I have been working on alternative garment constructions other than the bra, whose construction principle is based on breast symmetry and which does not work without breasts of the same size and weight as anchor points.

As you said, bodies are generally very different and definitely not symmetrical. Therefore, in order to support the natural body as it is, I have concentrated on the customizability of breast support. Using 3D body scans and the development of a digital double, the unique topologies of each breast and upper body were captured and used as the basis for placing small tiles that strategically fix the elasticity of the knit. This pattern is adjustable and runs across the upper body in such a way that the desired areas are supported to varying degrees. Theoretically, this additional breast support in terms of modular engineered knit could be integrated simultaneously within industrial manufacturing processes in the clothing industry. However, during the prototype development for embrace, this was still a very labor-intensive and sometimes manual process.

In order to embed the expert knowledge reversal within the design process of embrace during design development, I always integrated a person affected by breast cancer into my team who was able to contribute their opinion as an expert in the wearing experience. I recall one special moment when the participating wearer described how she felt wearing the breast support customized to her body. She said she felt safe and gently held and equally supported, relieved and light, which reminded me of Alber Elbaz’s description of embracing the wearer through clothing.

Empa, the Swiss Federal Laboratories for Materials Science and Technology, is currently testing this specific textile surface in order to study its textile properties from the perspective of textile science.

Gloria: Excerpts from your research show that conventional medicine often advises breast reconstruction after a mastectomy, but in many cases this does not necessarily contribute to the mental health of those affected, and may instead be associated with severe pain and other health problems such as inflammation due to implants. Can you explain why this is still increasingly being recommended?

Silke: That’s a good question that I’ve often asked myself. Statistics, if they exist, are not published to the extent that would reveal how many people with reconstructed breasts experience complications or to what extent consultations influence the decisions of those affected.⁶ A senior oncologist and head of a German breast care center once explained to me that such information is simply not recorded. I’m also unsure whether it is necessary to quote the statistics in order to recognize the existing level of distress. The stories of those affected that I hear in this context paint a picture of the overlooked needs of individuals who decide against breast reconstruction or, for example, have their implants removed again.

The exchange between the participants during the Participatory Clothing Design Sessions seemed to me to be a kind of mutual comparison and confirmation of individual body realities. »What are my needs and what are the needs of others who are working on their prototypes right next to me?« To my mind, the creative process through which participants either entered into conversation with each other or actively assisted and observed each other attentively, has the potential to soothe and counteract feelings of loneliness and marginalization. The diverse shapes and sizes of female bodies in the same room also supported gentle self-reflections. »What does my body experience, what is it capable of, what is it there for and how is it doing right now?« and »What does my body need in order to feel good?«.

Gloria: The space we give the female body and how we view it has changed in the 20th century. The world of art has altered dramatically over the centuries thanks to artists such as Judy Chicago and Emma Shapiro. Here, the male gaze was no longer in the foreground and an awareness of the fact that nudity is not synonymous with pornography was created.

Silke: I find it interesting what you say about the male gaze in art history. In the context of wearing clothes, people also apply this external view of their female body to themselves. In terms of self-awareness coming from within, exciting and important clothing design research studies such as the participatory study by Katherine Townsend, Juliana Sissons and Ania Sadkowska now exist, which addresses the ageing process of the female body and the scarcity of choice on the clothing market for individuals concerned.⁷ Industrial designer Patricia Moore began to examine society’s view of the female body, as well as this internalized outside view in the late 1970s. She undertook a pioneering design research experiment and lived – she was a young woman at the time – in an age suit, a full body prosthesis as an 85-year-old senior citizen experiencing a series of health scenarios and different levels of prosperity. She later described how deep and irrevocable the wealth of experience with which she emerged from this experiment was, and how it led to the realization that human dignity must always be at the forefront of design in order to actually improve the quality of life of consumers.⁸

Gloria: Epistemological philosophy also emphasizes the incredible significance of personal experience.

Silke: When people affected by breast cancer face medical experts in the healthcare system, who supposedly have superior knowledge, this expertise is based on specialist knowledge and professional experience, but evidently does not constitute expert knowledge of someone’s own intrinsic experience on an everyday basis. If the interpretive authority in such encounters between practitioners and patients is attributed exclusively to medical expertise, this creates a disconnection, even a dissociation, as regards intuitive knowledge about one’s own experience and needs.

Gloria: At the same time, the prototype in medical research has long been the man, or in some cases still is today, and gender-specific research is only gradually taking shape.

Silke: It is remarkable how little we know about female health and the processes in the female body and the limited extent to which this forms part of our general education. In my research practice, I have found that creative, participatory methods such as the Participatory Clothing Design Session can be helpful tools for drawing attention to overlooked issues in the context of female health that are otherwise hidden or a source of shame.

Looking ahead, I am interested in exploring further how the self-perception of one’s own female body and one’s own garment wearing experiences and clothing needs can be given even more creative expression. I hope that the knowledge production of clothing design research in contexts such as care and participation will develop a clearer profile in an academic context, that a disciplinary framework for applied clothing design research in the context of female health will become more established, and that practical clothing design research methods will be elaborated with increased intensity.

Translated from German into English by Harriet Rössger.