MLD for Post Surgical Recovery - How to heal faster from your tummy tuck, mommy makeover, BBL, breast reconstruction or Lipo procedure
Within the past decades a whole new form of post-surgical healing has emerged – Post Surgical Manual Lymphatic Drainage.
While there are therapists trained to perform MLD for Lymphedema, and other health and wellness purposes, they are not necessarily trained or believers in applying MLD to patients recovering from cosmetic or non elective procedures. . Evidence of it's growing popularity is in the number of post op clients who call saying their surgeon "prescribed" MLD as part of their followup protocol.
The Lymphatic System
The Lymphatic System is a complex pathway of specialized capillaries, trunks, and nodes which assist in returning fluids back into the circulatory system. As a passive system, it has no central pump, like the heart, to move fluids. That task is left to the vein like structures to "pump" fluids,
The post-surgical case for MLD
Inflammation. (and fibrosis). It all really comes down to inflammation. Surgery is trauma. And trauma triggers a trauma response. Part of that response is swelling. Swelling is a normal part of healing, but it can be uncomfortable and chronic swelling can lead to other issues. Manual Lymphatic Drainage helps the lymphatic drainage system function at a peak level to draw fluids away from a swollen area. Stimulation of the lymphatic system increases the rate at which the body removes waste, dead cell particles, and inflammatory agents from our tissue.s Accelerating the lymphatic flow has been demonstrated to reduce swelling and bruising in the injured region. Studies indicate that as the volume of fluid at the injury site is reduced, rehabilitation time may be shortened. Manual Lymphatic Drainage (MLD) can play an important role in post-surgery recovery to reduce inflammation but also by playing a role in the reduction of pain, stiffness and bruising,
You may receive Post-Surgical MLD treatments within 3 days after surgery.
Doctors who know of Post Surgical MLD will sometimes suggest treatment as soon as 3-days after surgery. This early intervention assists with helping to minimize bruising and swelling. However, some doctors suggest or even mandate patients wait from 2-6 weeks after surgery before receiving treatment. With a Doctor's permission, I will work on clients generally beginning 3 days to a week after surgery. No work will be done on or near an incision this early - only after it has healed. Generally after 2-3 weeks all work is safe unless there are complications with your surgery.
Your MLD Therapist should have wound care or medical training if you have issues with your surgical site.
One current trend we are seeing is that patients are flying out of state or out of the country for cosmetic procedures that are more affordable. Often the client returns home with a paper of "instructions" and there is no real medical followup. MLD itself can only do so much, and some Doctors are simply passing the patient responsibility forward. If you are experiencing any issues such as abnormal oozing, sharp pain. redness that is abnormal or other signs of infection, please seek competent local medical care or see your doctor if local. MLD therapists only do what they do which is limited.
Pushing fluids and tissues out from unhealed incisions is NOT MLD
There is a "understanding" in various places in the United States and abroad that the way to get lymphatic fluid out of your body is to reopen the incisions and push fluid out manually. First, this process is outside the scope of practice (100% illegal) for any massage therapist or MLD therapist in any of the 50 United States. Unless the person performing this process is a nurse or similarly licensed healthcare worker in a clinic with biohazard bags, gloves, face shield, gowns, etc., they should not be doing this. If you are a surgery patient and someone wants you to do this, or to do this to you, run.
YouTube videos are NOT an alternative to hands-on MLD - But I can show you Self Care MLD strokes you can do at home
When time and budget allow, MLD is best performed by a trained therapist, however not everyone has the time or budget for a series of visits. One challenge with online videos is that you never know what you are getting. I see massage videos all the time that contradict the actual work. Further it is easy to "mimic, " maybe, but if you don't know the "why" behind what you are doing, or know if you are doing it right, you may be doing things contrary or ineffective to the healing process. If you want to do MLD self care at a minimum, book a treatment with some extra time and go home with a self care routine that you know will be effective.
MLD does NOT use brushes, tools, cupping, bamboo sticks, rollers, or creams.
MLD uses only the hands and is performed without oils, lotions or creams. It involves movement of the skin in particular directions, and gentle pressure toward the body. Any other technique, tool, cream, or even cupping, is not part of the Post Surgical MLD process and should be avoided. If you have a therapist who is insistent on using creams, tool, cups or rollers, just say “No!” and tell them to use hands only. If they refuse, simply end the session and leave. There are instances where cups and tools can be used during the healing process, but it is not for lymphatic drainage.
You Deserve a Better Healing
In all cases, a post-surgical lymphatic drainage session should be gentle and complete, Post surgical MLD is an excellent way to help promote the healing process and is appropriate for almost any surgery or procedure.
I treat clients in my Needham, MA office who have had procedures such as lipo-360, mommy makeover, breast reduction or augmentation, Brazilian butt lifts, abdominoplasty (tummy tucks), cool sculpting, brachioplasty, facelifts, hip replacements, shoulder surgeries, lumpectomies, mastectomies and reconstruction, gender affirmation surgeries. . If your situation involves Lymphedema, active cancer or is in general more complex, my colleague, Virginia Murphy, is available to handle almost special care cases from her nearby Hanover studio, She has hundreds of hours of training in oncology massage, lymphatic systems and manual lymphatic drainage. We would like to be your healing partner. Together, we see clients on Martha's Vineyard as well, me year round, Virginia from spring to fall.
Would you like to learn how to incorporate full chest and breast into your wellness massage sequence?
Do you have clients that would benefit from this work? Is it legal in your area? The answer here may surprise you - read on.
Why include chest & breast massage in a full body massage?
After all, we were taught "Stay away from the chest", "it is illegal" "It is or could be considered sexual".
The fact is - breasts are a healthy and normal part of our bodies. Massage can reduce pain and swelling, support range of motion, and promote circulation and relaxation.
Further - It feels wonderful to receive and helps receivers experience innocence in our body that we may not have felt since early childhood. It is non-sexual and it is an excellent and wholesome component of any wellness massage for men and women..
Why not provide our chest and breasts with the same benefits that we give the rest of the body?
Massage of the full chest supports easy breathing, relieves tension, assists with back, neck and shoulder pain, relieves chest tightness and reduces tension in the rib cage, neck and throat. Easy breathing leads to physical, emotional, mental and spiritual stress relief. Massage of the chest is also useful in treating shoulder and neck injuries.
Massage of the breast tissue itself can aid in lymph flow, help relieve congestion and discomfort related to menstrual periods, fibrocystic conditions and lactation.
After open wounds have healed, massage also helps relieve restrictions and scar
tissues post-surgery, including open heart surgery, mastectomy, breast reconstruction, breast reduction and breast augmentations.
In May 2021, my friend, sometimes mentor and colleague Barbara Helynn Heard, LMT announced that she was going to step away from teaching and massage practice to devote more time to living end enjoying life. Barbara is an amazing person and an inspiration. She was one of the first people I met professionally as I contemplated embarking on my Lomi journey and massage career. Her kindness and spirit were and are an inspiration. Barbara had made it a mission of her later career to normalize full chest and breast massage within the context of a therapeutic treatment. She created the first class in Seattle on full chest and breast massage and when she offered me the opportunity to carry on with this teaching, I said yes.
As of May 2021, I have been offering a Full Chest & Breast Massage Class as a 16 hour Continuing Education Class. As well., I offer a 4 hr "Intro" class that is suitable for all schools across the county. In the "intro class, we do not work the chest undraped, it is merely to introduce the concept, answer questions and to help guide students toward the 2 day course if that is what they choose.
BOTH courses are NCBTMB approved as continuing education and the 2 day course is accepted by the State of Washington to satisfy their requirement to work in that State.
I generally offer this course in Boston a few times a year. In addition, I am available to teach it anywhere in the country if you know of a facility that would like to host it, or if you can generate enough student interest.
Also, it is a mixed gender course, open to all Licensed Therapists with a sincere reason to want to learn, and provided it fits or could fit into their current offerings. Every student is vetted, however and not every person is able to be admitted. The proportion of male to female students is very low, similar to that of the therapist population, about 1 in 10. That said, I do my best to keep a ratio along those lines.
Lastly, in recognition of the number of female therapists who may have women only practices, or may wish to learn this material in a single gender environment, I do offer the course in a singe gender version a couple of times a year also.
If you are interested and would like to learn more about the class, please go here
If you would like to more more about the practical benefits, read testimonials, see if it is legal in your area, you may go here
I’ve been devoted to learning, and now teaching this alongside my Hawaiian Lomi work
for the past many years. I would be delighted to introduce you to this wonderful world of healing touch to share with your family, your community, the world !
Again, I am also available to bring this teaching to you, worldwide. If you would like to organize a facility and a small group of students in your area, or at a retreat site, simply email me and I would be happy to talk with you about bring the training to you.
What are your thoughts? Please leave them here !
Is Breast Massage Legal in my State ?
I get asked this question from time to time. Why? because as a massage therapist and as a massage teacher of continuing education, I provide clients with the option of full chest and breast massage within the context of an overall wellness massage. Further, as an NCBTMB approved Massage Instructor, I offer Massage Continuing Education courses in full chest and breast massage.
So the answer to this question is, "it depends". There are a number of misconceptions within massage as in any industry or profession, where ideas or notions are handed down verbally or spring from somewhere, usually someones opinion, and over time some of these ideas morph into things people take as fact. For example in my state, Massachusetts, it is a widely held belief that breast massage is either not legal, or that undraping of the breast is not allowed. As to the the draping, the MA State Laws governing massage do not mention draping - however some local Board's of Health Regulations do.
The point is, if you are curious if it is legal where you live, whether as a client or as a therapist, check with laws, don't rely on heresay.
My friend and colleague, Barbara Heard, had made it her life's mission, prior to retiring from teaching, to normalize full chest and breast massage and to make it legal in all 50 States. She tirelessly collected data from each State Board, wrote into officials where there were gray areas and created a comprehensive list that you can refer to here . If you spot any differences or updates to this information relative to your area, you may email Barbara and I'm sure she will update the page. I also provide a link to it on my website as well as alot of information about the benefits, both physical and emotional.
It is an uphill battle for normalization in the US although these values have shifted, form the 70;s when it was more commonly taught as part of a mainstream curriculum.
Public perception, social norms, which vary from region to region, and the continued confusion in the eyes of the public between legitimate massage and adult services that are labeled as massage or bodywork, bear on the challenge of mainstream acceptance, at least to the point where it can become more about a client's choice.
Breast massage has been regarded at best, as an integrative measure in a holistic alternative therapy, or at worst, as an invasive and abusive undertaking, if offered without informed consent in the hands of a therapist lacking experience or integrity. This is the crux of the issues surrounding breast massage. Breast massage administered by trained massage therapists will be more readily accepted by the (American) public if its medical or emotional rationale are spelled out for clients, and if therapists receive adequate training in its psychological ramifications and the appropriate use of specific techniques.
Barbara's view, and one that I share is that it should be legal and it should be up to the client - it will take grass roots efforts to bring about change in the states that prohibit any touching or undraping of the chest. In Washington State, to use as an example, Barbara was able to almost single handedly reverse the Board decision from making it it illegal to making it legal, provided the therapist has sufficient training and with a client's full informed consent. In other words, Washington State had no mention of draping on their books, but when a proposed law threatened to make it illegal, Barbara was able to get them to reverse their decision provided she create a course to properly train therapists in both how to communicate the work and obtain consent as well as how to perform the work safely and professionally. This is the course that I have taken over since her retirement.
It is my hope that Washington State can serve as a model for every other state in how to handle it properly which is to say, properly train those therapists to perform it for those clients who wish to receive it. It may never gain broad mainstream acceptance but it should be available to those who seek it, denying them that choice simply seems wrong.
If you are a massage therapist and stumbled onto this blog post and are interested in learning more about my Chest & Breast Courses, please go here
If you re a client or a potential client and would like more information, I have a number of blog posts, but you may also check out the resources here
The Missing Pieces: Less and less body is being included in "full body" massage - It doesn't have to be.
This article came across my desk and caught my attention. The discussion is about how and why more and more, therapists and schools in the US are backing away from a true full body experience. It does not have to be. with proper training, good client communication and informed consent there is no reason why in 2019 this should be. I have interjected my thoughts in italics, but otherwise this is re presented in abridged form from Massage Magazine. published from
The anterior (front) torso, including the chest and abdomen; hips; buttocks; and medial thigh are often avoided or only given cursory attention during many massage sessions.My awareness about this developed after reading many posts on social media about “full-body massage.” Discussions with massage colleagues, educators and therapists indicate this problem is real. I Have seen many posts about the chains not allowing massage 1" below the collar bone, or glutes at all.
“There is a significant decline in the number of massage therapists that are willing to perform massage therapy on gluteal, pectoral and abdominal areas,” said Brent F. Jackson, academic program manager, massage therapy, at Central Carolina Technical College, headquartered in Sumter, South Carolina. He said he believes there are three factors contributing to this situation.
First, he said, massage therapy businesses and schools alike are wary of being involved in litigious situations, because of criminal acts by some massage therapists have made the news and are therefore overly conservative when it comes to creating curriculum.
Second, he said, “In academia, we are also encountering a broad spectrum of skill, and therefore a possible lack of qualified and confident massage therapy educators. That lack of training may be inhibiting the student’s professional growth.”
Third, said Jackson, there is simply a growing trend of the therapist not wanting to put in the effort required of a true full-body massage. Instead, he said, therapists are cutting corners.
“As a profession,” Jackson said, “it is necessary to be open to treating these areas when warranted, as would any other health care professional.”
Educator Nancy Dail, of Downeast School of Massage in Waldoboro, Maine, has also witnessed this trend. “I have long been aware that massage therapists have been cutting corners around the human body, basing massage on a rote recipe and repetitive sequence versus a treatment based on the individual’s medical history, posture, repetitive actions or injuries,” she said.
“Since society has a vulnerable perception of the abdomen, it has been the most logical area to skip,” Dail continued. As to other areas, she said, state regulations on breast massage, draping and professional conduct have led to restrictions on how the client’s body is addressed.”
However, student ignorance and state regulations cannot fully explain the diminishment of the full-body session. In my research and conversations, I have come to realize there are three pieces to this situation: incomplete massage education; apprehension on the part of clients; and insufficient informed consent across the profession.
Massage Education“Attempting to avoid excessive intimacy, my students’ hands often tense up around buttocks, chest, belly and inner thighs. I teach them instead to deliberately connect with these tissues using safe touch,” said Barbara Helynn Heard, a continuing education provider and practicing massage therapist in Seattle, Washington.
Although many massage schools provide a comprehensive education that prepares students to offer complete, full-body massage sessions, Heard’s approach isn’t how all massage students are being taught to touch clients’ bodies.
I, and many other massage educators, believe some schools’ entry-level education falls short in developing skills in positioning, draping, time management, communication and consent about the process of massage. Massage education sometimes creates fear related to boundaries and sexual misconduct litigation instead of developing professionalism. Instead of assessment and critical thinking skills imbedded into the massage session, a massage sequence is sometimes drilled into students.
For example, the common statement, “Disrobe to your level of comfort,” only creates confusion. Instead, direct instruction needs to be given. Such an instruction might sound like one of these two examples:
“I regard the anterior torso as crucial, yet it is avoided in 90 percent of the massages I receive,” said Eric Stephenson, who was interviewed for this article when he was director of education at imassage continuing education and consulting company and who is now chief wellness officer for Elements Massage. “This is one of the great paradoxes of massage therapy.”
Part of the problem, in my opinion, is that the two national massage organizations do not accurately educate the public. One association’s website states, “A typical full body session will include work on your back, arms, legs, feet, hands, head, neck, and shoulders. You will not be touched on or near your genitals (male or female) or breasts (female).” This statement essentially omits the chest, abdomen, hips, buttocks, thighs and face. With these areas unmentioned, what type of expectation does this create in the consumer and employer?
Another association’s website states, “Depending on your needs, the massage therapist will massage either the full body (except private areas) or only specific areas that need attention, such as especially tight muscles.” This statement is so ambiguous that the information is confusing. What are private areas?
Despite professional strides in the massage industry, confusion between massage therapy and illegal sexual solicitation continues to occur. Something must be done so that the massage therapy profession as a whole can move beyond this degrading situation. I challenge our professional organizations and major employers of massage therapists to collaborate and directly address this issue.
Additionally, there is gender bias pertaining to male massage therapists.
“As a male therapist, I have to maintain trusted professional relationships with clients, [which includes] education about various body areas included in the massage session, to achieve client goals,” said massage therapist (and my son) Luke Fritz, an instructor at my school, Health Enrichment Center in Lapeer, Michigan.
I believe the massage field should launch a public awareness campaign that clearly discusses sexual inappropriateness by both the client and the massage therapist, and that describes body areas included in general massage coupled with an example of informed consent. There should be ethical guidance by our professional associations and employers that frames clear statements to the public and massage therapists about appropriate behavior.
Such a statement might read: “Massage therapy is a nonsexual health service. Sexual behavior by the therapist toward the client or by the client toward the therapist is always unethical, inappropriate and illegal. It is always the responsibility of the massage therapist and business management to ensure that sexual misconduct does not occur and to report sexual solicitation by clients to law enforcement. Clients who feel that the massage therapist engaged in sexual misconduct should immediately report to the business management and to law enforcement.”
The problem is that major employers are accepting substandard massage as the norm.
One reason for this may be that the confusion between massage and sexual interaction will just not go away, so employers might limit massage application to particular body areas because of the fear of sexual misconduct lawsuits.
It is very concerning if we have come to believe that the major body areas cannot be massaged in the typical 50- to 60- minute session. Massage employers and clients need to be assured that all massage therapists are providing quality massage services and can provide massage to all appropriate areas of the body.
I welcome comments on all my posts but especially would welcome comments on this one. What has your experience been? What is your preference?
Original Article written 10/17 - updated 5/2019 with resources
UPDATE / PART II TO AN ARTICLE WRITTEN 10/17
With this subject coming up more and more online and with clients, here are some further thoughts utilized t.
Breasts aren’t usually invited to the self-care party—despite the fact that there’s a restorative practice for pretty much every other part of the body (hair included). But there’s an argument, more than one, for incorporating full chest and breast massage into your treatment.
“Massage is a wonderful, stress-relieving, detoxifying practice for the whole body,” says natural beauty expert Jessa Blades.
“It’s odd that we don’t massage the breasts [in the West].”
And no, you don’t need to be pregnant or nursing to reap the rewards, a fact the holistic wellness world’s been clued in to for ages. “In Ayurveda, if you get a full-body massage, your breasts are massaged too,” Blades notes. “It’s odd that we don’t massage the breasts [in the West].”
Breast massage may provide huge psychological and emotional benefits, especially for those recovering from breast disease and the aftermath of invasive treatments.
While this work is not even close to being mainstream at the moment, that’s starting to change as word gets out about the physical and emotional benefits the practice produces. And lets not forget about choice. There is an emotional long tail effect about subconsciously feeling the need to "hide" them.
Breast health is too often ignored until after a problem arises. It’s an area of the body with powerful associations that sometimes makes women hesitant to seek care, despite the fact that the vast majority experience discomfort at some point.
Breasts are often compressed with sports bras, constrained by underwire, or enhanced with padding. This can restrict the flow of lymph, the clear liquid derived from blood that contains disease-fighting cells called lymphocytes. It is widely speculated that chronic impairment of lymph drainage may be implicated in many breast health problems, including cancer.” This is the case for not wearing a bra.
Therapeutic breast massage also loosens the tissues of the chest, shoulders, and neck, using a combination of deep-tissue massage techniques, movement, breathing, and stretching. Whether your breasts are healthy or compromised, every woman can benefit from this work, and it can be a powerful aid to emotional healing or healing after surgery or radiation therapy.
If you are It is important that you find a therapist who is qualified; trained and experienced with this work. Just as it is surprising to many clients, it is surprising to many therapists. A qualified therapist will be able to explain the work, discuss benefits, address curiosities, fears and or/concerns, go over the protocols for consent and choice - and ultimately help determine if you might be a good candidate for this work.
I have created an FAQ page that for the moment is password protected. It contains further discussion, FAQ's, and other information along with testimonials. If you would like to access it, please go here
Here is a list of prior blog posts for further reading on this topic:
If you have had breast massage and would like to share your story, it may help others - please send me an email.
A Really Good Massage Blog
I write about things that I myself need to be mindful of. ways in which I would like to improve. It is not from the perspective of preaching - but rather writing helps me work out what I myself need to do - we are all in this together.