Sweet Dreams: Post-Mastectomy Sleepwear
2009-2011
Background
I collaborated with a research team challenged with developing sleepwear for women who have undergone a mastectomy due to breast cancer. Breast cancer is the world’s most prevalent cancer; as of 2020, there were 7.8 million women living with the disease, globally (World Health Organization). Mastectomy and lumpectomy are procedures that remove cancerous breast tissue, often resulting in physical asymmetry. Many women who have undergone these procedures (and who have not had reconstructive surgery) prefer to camouflage this asymmetry. This can be achieved with prostheses and/or strategic garment styling. It is more difficult to camouflage with sleepwear because it is not always practical or desirable to wear a bra under a nightgown or layer extra garments on top of pajamas to camouflage.
Our team consisted of apparel designer scholars (including myself) from Toronto Metropolitan University and research scientists from Princess Margaret Hospital. We aimed to design comfortable, attractive sleepwear that provided camouflaging features to promote a positive self-image for women who have had surgery related to breast cancer. To do this we needed to gain a deeper understanding of the clothing-related needs of this cohort.
My Role
In this project I coordinated focus groups, conducted phone interviews, conducted usability tests, transcribed audio recordings, thematically analyzed qualitative data, co-developed sleepwear designs, created technical illustrations, drafted sewing patterns, and produced garment prototypes.
Challenges
It was essential to speak with women who have had a mastectomy or lumpectomy to empathize and understand their needs, but our team recognized that doing this would put participants in a vulnerable position because it may be distressing for them to revisit the emotional trauma they experienced during their cancer treatment and surgery. One of our team leaders was a cancer survivor; this gave us some insight into how to approach these delicate conversations.
Methods
This research was conducted over three phases: a needs analysis, prototype design & feedback, and field test. Multiple methods were employed in the collection of qualitative and quantitative data:
Secondary research
Existing literature was consulted to identify existing research on post-mastectomy clothing needs and wants.
Demographic Survey
Demographic surveys provided information on participant age, location, etc. as well as single or double mastectomy, lumpectomy.
Focus Groups
Focus groups were conducted in each phase of the study to gain insights into sleepwear needs and design preferences.
Usability Testing
Designs were tested with participants to confirm that features worked as intended and were easy to use.
Field Testing
Participants wore and laundered the sleepwear for three weeks to test performance in their normal home setting.
Phone Interview
Following field tests, phone interviews collected input on design performance, durability, comfort, and user satisfaction.
Results
Participants highlighted clothing concerns regarding accessibility and affordability, and provided specific recommendations on garment colour, comfort, cost, and cut (e.g. deep V necklines without a base layer were undesirable as they exposed scarring). Responses demonstrated that the asymmetry resulting from a missing breast can impact self-confidence. Participants requested designs that provided strategic camouflage to help support positive self-image following a significant physical change. In addition, cancer treatment often causes skin sensitivity and hot flashes, so participants indicated that fabric selection needed to be supremely soft and breathable, and designs needed to consider seam style and placement to reduce pressure against the skin. Sleepwear is often associated with intimacy, and participants wanted something they felt sexy in.
Designs were developed to discretely accommodate participant needs, which allowed anyone to wear the garments even if they did not require the special features. A nightgown and cropped bolero jacket were produced from a soft knit fabric made from a blend of rayon (from bamboo) and cotton.
Sweet Dreams: Nightgown and Bolero Final Designs
Copyright 2022. Not to be used without permission.
The nightgown features a draped collar and mock deep-V neckline with a soft lace panel underneath. The folds of fabric on the draped collar camouflage breast asymmetry. Built-in front bodice lining made from the soft knit fabric reduce seam irritation against sensitive skin. The bolero jacket features concealed pockets to insert a prosthesis; if no prosthesis is needed, pockets lay flat and are unobtrusive. The bolero enables a prosthesis to be worn in an outer garment layer as opposed to in an undergarment (usually a bra), making it an easier process to transition from public to private spaces (simply add or remove the jacket).
Sweet Dreams: Nightgown and Bolero Line Drawings
Copyright 2022. Not to be used without permission.
Impact
Participants who field tested the design were happy with the result, one woman felt the nightgown was nice enough to wear in public as a dress. Others commented about not having to worry if they had their bra and prosthesis on when making breakfast for their family or guests. Many reported increased self-confidence and positive self-image.
Media
Publications
Tullio-Pow, S., Schaefer, K., Nyhof-Young, J. & Strickfaden, M. (2020). Sleepwear for Breast Cancer Survivors: Enacting Inclusion Through Feminine Identity and Attachments. In: Langdon P., Lazar J., Heylighen A., Dong H. (eds) Designing for Inclusion. CWUAAT 2020. Springer International Publishing AG, Part of Springer Nature 2020, p. 23-34.
Tullio-Pow, S., Schaefer, K., Nyhof-Young, J. (2011). Inclusive post-mastectomy sleepwear: Toward sweet dreams for all. In ITAA 2011 Proceedings: Celebrating Inclusivity & Innovation (pp. 79-80). Philadelphia, PA. November 2-6. Winner: ITAA Creative Design Target Market Award
Tullio-Pow, S., Schaefer, K., & Nyhof-Young, J. (2011). Towards Functional and Inclusive Sleepwear Designs for Breast Cancer Survivors: A Comparison of Two Fabrics. In ITAA 2011 Proceedings: Celebrating Inclusivity & Innovation (pp. 14-15). Philadelphia, PA: ITAA.
Tullio-Pow S., Schaefer, K., Zhu, R., Kolenchenko, O., Nyhof-Young, J. (2011). Sweet dreams: Needs assessment and prototype design of post-mastectomy sleepwear. In INCLUDE 2011: The Role of Inclusive Design in Making Social Innovation Happen. Helen Hamlyn Centre, Royal College of Art, London. Include.
Reflection
Going into this study I expected we would be solving aesthetic and fabric-based problems and had not considered the full scope of the emotional impact of living with a mastectomy as a cancer survivor. One of the key themes that arose in this study was sexuality, and how women felt that society assumed they were no longer sexually active or interested in pursuing intimate relationships. Our participants rejected this assumption and requested sleepwear that made them feel desirable, along with the comfort and camouflage features we anticipated. The fabric selection process was also insightful. We had selected some technical fabrics with superior moisture-wicking and breathability, but the fabrics were not soft and participants rejected these in favour of the softer fabrics without the improved performance properties. This was an important reminder to never assume what the users want and to always test actual materials with the user group to identify preferences.