By Debra Curties, R.M.T.

Breasts are body tissues with their own health needs. At some point in time, most women will experience breast congestion, breast pain, discomforts of diagnostic or surgical procedures, and anxieties about lumps or other changes in their breast tissues. Pregnancy and breastfeeding have their set of associated breast tissue needs. Unfortunately, many women experience physical and psychological trauma related to their breasts. And then there is breast cancer - impacting directly on the lives of many women, and indirectly on all of us.

Conditions and occurrences affecting breasts lead women to seek medical help and to self-medicate. Statistics indicate many women complain of breast pain to their doctors. At the same time, most sources reporting these stats believe women underreport breast problems, presumably for similar reasons to those which lead us to be uncomfortable about breast massage.

The fact that breasts are strongly associated with sexual touching and attractiveness does not mean they cannot or should not receive health care. In fact, this symbolism adds a set of psychoemotional concerns many women need help with in order to feel more at ease about doing routine self-examination and seeking the therapies they need in a matter-of-fact way.

The multidimensional significance of breasts means health care practitioners involved with breast health must be carefully trained. We need to be able to deal with the significance and sensitivity involved in touching breasts, we need to be able to communicate clearly, and we need to know how to maintain good professional boundaries.

I cannot ascribe to the thinking that by examining or treating a breast (with consent), a trained health care practitioner is by definition doing something sexual. A therapist with sexual or abusive intent can convey this in the way he or she touches any body part, and with all manner of other verbal and non-verbal cues. The well-intentioned therapist will be especially conscious of avoiding any such possible interpretations when treating body parts known to be more emotionally charged. We assume doctors, nurses, lab technicians and others can appropriately handle the necessities of working with breast tissues. Are massage therapists so different?

Massage therapy is an effective "wellness" treatment for breasts, as breasts particularly need good circulation and tissue mobilization for optimum health. Poor circulation can produce various uncomfortable symptoms. Breast scarring (surgically and traumatically induced), which is more common than we often realize, can cause painful syndromes and obstruct blood and lymph flow. Some believe there may be a correlation between chronic poor breast drainage and susceptibility to malignancy. Massage techniques and hydrotherapy may in fact turn out to be some of the most effective modalities for addressing such problems and promoting breast health.

Many women need more help becoming comfortable with breast self-examination than they receive in their doctors' offices. Some have traumatic histories and need assistance achieving a sense of normalcy about their breasts and the types of touch involved in seeing to their care. As well, a skilled palpator may be more successful in picking up early-stage breast tissue changes needing medical follow-up than a client would herself. Given the time spent, the regular treatment intervals, the privacy of the circumstances, and the trained empathy and physical skill of the practitioner, massage therapists really have something to offer.

There are some very important safety concerns, both for the client and the practitioner. Some people have histories which can make it difficult for them to distinguish present realities from past experiences, and some people find it especially tough to talk clearly about what they accept and cannot accept as treatment - referring to both clients and health care workers. Our personal stories are often the same. There are no magic answers about how to identify the situations to avoid. Most of the confirmed disciplinary cases I am aware of have arisen from circumstances where the massage therapist did not communicate clearly, did not properly obtain consent, and/or did not maintain professional boundaries. However, there are some definite risks - there are high-risk clients and there are high-risk circumstances. It is important to keep in mind these circumstances are not exclusive to breast massage. Getting a good, basic education, finding a peer support group or a skilled supervisor once out in the field, and pursuing advanced training in specialized areas of treatment and client interaction are important safeguards.

Can we justify letting our concerns about risks cause us to completely overlook the legitimate treatment needs of breasts? Is it right that breast health care is not getting the attention from our profession that it should? Should women have to suffer from pain and other symptoms which could be ameliorated if we were comfortable addressing them in the way we would be for other body tissues? Is there any way massage therapists can help in the fight against breast cancer? These are important questions, and it is our duty as members of the professional health care community to give them serious thought. Breast massage will not be right for every client and every therapist, but are we doing our best to fulfill our profession's obligations? Are we wrestling in a principled way with the dilemmas involved or are we putting our heads in the sand?


For more information on this topic (including contraindications, breast anatomy and massage guidelines), as well as the importance of lymph drainage therapy for breast care, see the June/July 2001 issue of Massage & Bodywork. To order copies, go to the Reprint and Back Issues.