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.
I have just returned from certification training in full chest and breast massage on the west coast and the timing was interesting as October is Breast Cancer Awareness Month.
Although this work is not specific to breast cancer patients or breast cancer survivors, there are a number of physical and psychological benefits to those either facing this disease, going through it and recovering from it. Some of which I have discussed here.
During our training, we were fortunate to have among us cancer patients and survivors, including women who have undergone a partial lumpectomy, a double mastectomy, reconstructive surgery, enhancement and breast reduction.
If anyone needs and deserves the healing, caring touch of massage, it is women living with breast cancer, whether before, during or post-treatment. Massage and touch at any stage of breast cancer will take a woman to another place than her disease. Massage can assist her throughout her entire journey, from diagnosis to recovery. It can be difficult for the patient to deal with family issues, body image, finances, friends and do-gooders.
Massage can help.
When asked what massage does for them, clients have replied with comments such as:
Massage therapy has been shown to offer a number of benefits for breast cancer patients. Performed by a skilled and qualified therapist, the immediate benefits of massage therapy include reduced stress and anxiety. Long-term massage effects include reduced depression and hostility and increased serotonin values, .
Massage can also enhance one's feeling of well-being. It can stimulate the nerve endings in the skin, release endorphins (the feel good hormone) and inhibit the stress hormones, cortisol and adrenaline.
In a study published in the Journal of Psychosomatic Research, the Touch Research Institute found that massage therapy reduced anxiety and depression. It also improved immune function, including increased NK cell number in breast cancer patients. Additionally, breast cancer patients have improved immune functions following massage therapy.
Another study* found that therapeutic massage reduced cancer pain perception by an average of 60 percent, decreased anxiety by 24 percent and enhanced relaxation by 58 percent. A Touch Research Institute study involving 20 children with leukemia found that daily massages by their parents increased the children's white blood cell and neutrophil counts (neutrophils form a primary defense against bacterial infection).
Why Mastectomy Massage?
The benefits of mastectomy massage are numerous. The therapist's intentions and the quality of touch provided can make a world of difference to a client who has recently experienced a variety of invasive and painful tests and procedures. The intention is not to "fix" the client, but to provide love, nurturing, relaxation and quality of life.
Massage can relieve post-operative pain and edema, and promote the removal of toxins as it assists in the flow of lymph, blood and oxygen. Over time, clients will experience increased range of motion, reduced scar tissue, restored feeling and sensation by stimulating nerve endings, an improved body image and may become more aware and reconnected to themselves. Aside from massage generally promoting better health and overall well-being, it just feels good!
Can Massage Spread Cancer?
The concern that increasing circulation via massage will cause the spread of cancer is unfounded. Cancer can spread with little or no activity, such as sleeping, breathing, eating, walking, etc. Therefore, there is every reason to believe that gentle, light or compassionate touch can be administered safely and effectively, provided that no direct pressure or massage is applied to the traumatized area affected by disease.
Light massage may actually have a protective effect, as it keeps the blood and lymph circulating. Touch may help prevent tumor proliferation, as it reduces the body's levels of glucocorticoids and cortisol & hormonal measurements of the body's stress levels. Conversely, high levels of these substances in the body have been linked to tumor growth.
Massage therapy does not treat cancer. But it can have a profound impact on a patient's well being. If you are facing breast cancer, talk to your doctor about seeking massage therapy and then book an appointment to begin your journey of healing and self care.
- with aloha
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.