BEND — When Barbara Mounho-Zamora dresses to go out to dinner or attend a wedding, she wears a little something extra. Make that a pair of little something extra.

“I put on my knockers when I go out for special occasions,” the breast cancer survivor said.

The Bend woman is talking about hand-knitted breasts known as knitted knockers. When placed in a bra, they look like real breasts.

Knitted bra inserts may sound old fashioned, but for many women, such as Mounho-Zamora, who still suffer frequent pain after a double mastectomy and radiation therapy for breast cancer, the soft light cotton breasts are a breakthrough innovation in cancer recovery.

Knitted knockers are the opposite of expensive medical technology. They are knitted or crocheted by volunteers in an assortment of sizes and colors, with and without nipples. And they are free.

The grassroots phenomenon originated in 2007 with the owner of a knitting shop in Maine who had a personal experience with breast cancer. Since then, knitters throughout the nation have joined the effort. The Assistance League of Bend, a local volunteer organization, started making knitted knockers two years ago and has donated hundreds to St. Charles Cancer Center, Bend Medical Center and any individual who needs a pair.

Losing one or both breasts can be difficult emotionally and socially for many women. Mounho-Zamora, 52, was diagnosed with breast cancer three years ago. She had a highly aggressive form that spread to her chest muscles.

Breast reconstruction would have involved more extensive surgery and more pain. In her case, the surgeon advised her also to factor in a 50 percent risk of infection, which could delay follow-up radiation treatment.

“I was diagnosed at Stage 3,” Mounho-Zamora said. “I didn’t want to mess around. I wanted to put all my energy into beating cancer.”

About a year into her recovery, she was fitted with silicone prosthetic breast inserts in a special bra. She feels lucky insurance covered most of the cost, which can cost hundreds of dollars, but she found them heavy, painful and intolerable against tissue rendered agonizingly tender by surgery and radiation.

Mounho-Zamoro spoke of one night she wore them. She was two hours into dinner with friends when she had to excuse herself to the bathroom and remove them. This happened more than once.

“Sure, yes, it was awkward,” she said. “But I was in so much pain I didn’t care. It was miserable.”

Most of the time, “I’m really comfortable not having anything there,” she said. “I even go out to the gym. You can tell I’m a woman who has no breasts. I’m OK with that. The most important thing to me is that I’m alive. I survived. I beat cancer.”

At one of Mounho-Zamoro’s follow-up appointments, her lymphedema therapist handed her a pair of knitted knockers to try. “She brought out a basket of them,” she said.

That was in 2017.

Karina Klaver, a lymphedema therapist at St. Charles Cancer Center, had been hearing some women describe the silicone breast forms as too painful or too heavy. Others couldn’t afford the breast prosthetics and were stuffing socks in their bras. She discovered knitted knockers online and arranged to supply them in the clinic.

“I like that we are able to give women in our area more choices,” Klaver said. “They have been through such big changes in their bodies. It’s good to have more options to make them feel more like themselves.”

The knitted knockers were a hit. Klaver couldn’t keep up with the demand. Then, she discovered a local source. A twice-monthly knitting group affiliated with the Assistance League of Bend, a local volunteer organization, had been making hats for people undergoing chemotherapy. The group heard about knitted knockers. It seemed like a natural extension of their efforts.

In June 2017, dozens of newly hand-crafted breasts were on display for the first time at the League’s booth at the annual Heaven Can Wait 5K walk/run, a commemorative road race that raises money for breast cancer in Bend. The volunteers wore buttons that read, “Ask me about my knockers.”

At first, “we had to push them on people,” said league spokesperson Valerie Holcomb. “We even walked around with a basket full of these things. But people who get hold of them love them.”

Last year, the league produced about 1,600 hats and 300 sets of knitted knockers.

The groundswell of knitted knockers in Central Oregon reflects a broader interest in this grassroots option across the country. At least two U.S. websites coordinate patterns and knitters.

After the grassroots effort was well underway in Maine, the knit shop where it began closed in 2010, but a knit shop in Tempe, Arizona, got hooked on the idea for a regional cancer center there. In 2015, the project became an independent nonprofit incorporated as Knitted Knockers Charity. The website lists similar groups internationally in Australia, Canada, England, Finland, Germany and South Africa.

In the Pacific Northwest, a woman in Bellingham, Washington, picked up the yarn. She experienced knitted knockers as a breast replacement after her own mastectomy in 2011. She founded knittedknockers.org to connect knitters, patterns and women with breast cancer and their supporters.

The Washington site reports more than 1 million downloads of the patterns, some of which originate (with permission) from the original Maine shop. Knittedknockers.org sends out 200 pairs per week all over the world, it reports, including a recent shipment of 100 to women in Rwanda.

In Bend, Holcomb thinks knitted knockers have not reached their full potential. “It’s been fun to see this take off, but we’d like to reach more people who can use them and more people who want to make them.” Knitted knockers are a level above her skill set, Holcomb said, who makes hats.

The knitted knockers have a small opening in the back so the fluffy filling can be removed or added to find the right fit, Klaver noted in an email follow up.

“I always recommend choosing a larger cup size than you think you need and removing some of the batting,” she wrote. “The bra will then squish the knocker and larger cup size with less batting will look more natural.”

Despite often light-hearted talk about the knockers, the individual impact touches the knitters and the breast cancer survivor deeply. Holcomb shared a heartfelt hand-written thank-you note from a woman who said she avoided going outside in summer after her mastectomy until her sister gifted her a set of knitted knockers.

“I hope every woman who goes through a mastectomy and hasn’t had reconstruction has that option,” Mounho-Zamoro said.