The fashion industry is facing increasing pressure to move toward sustainable development, especially with concern to cost and environmental sustainability. Innovative digital technologies are regarded as a promising solution for fashion companies to resolve this issue. In this context, this paper put forth a new 3D reverse garment design approach embedded with a garment fit prediction and structure self-adaptive adjustment mechanism, using machine learning (ML) techniques. Initially, the 3D basic garment was drawn directly on the scanned mannequin of a specific consumer. Next, a probabilistic neural network (PNN) was employed to predict the garment’s fit. Afterwards, genetic algorithms (GA) and support vector regression (SVR) were utilized to estimate and control the garment structural parameters following the feedback of fit evaluation and the consumer’s personalized needs. Meanwhile, a comprehensive evaluation was constructed to characterize the quantitative relationships between the consumer profile and the designed garment profile (garment fit and styles). Ultimately, the desired garment which met the consumer’s needs was obtained by performing the routine of “design–fit evaluation–pattern adjustment–comprehensive evaluation”, iteratively. The experimental results show that the proposed approach provides a new solution to develop quality personalized fashion products (garments) more accurately, economically, and in an environmentally friendly way. It is feasible to facilitate the sustainable development of fashion companies by simultaneously reducing costs and negative impacts on the environment.