Written by Sam Mishra, The Medical Massage Lady
Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology and lymphatic practitioner, trauma practitioner, breathwork facilitator, reiki and intuitive energy healer, transformational and spiritual coach and hypnotherapist.
Having worked as a surgical nurse, I have cared for many women who have undergone a mastectomy, and this has continued over the last four years in my role as an oncology practitioner, where I have combined my knowledge of mastectomy surgery, woundcare, breathwork, and my experience with oncology, lymphatic, and scarwork massage. I am now starting a breast program for those who have undergone mastectomy, although it is also applicable to other types of breast surgery, including gender reassignment surgery.
The current issue with mastectomy rehabilitation
We all have breasts, and they require just as much care as the rest of the body, if not more. The combination of cultural and media-driven imagery and individual emotional reactions has distorted our perception of breast massage.
In the UK, 11,500 people die from breast cancer every year, and with just under 57,000 new cases, the survival rate is 76%. 23% of cases could be avoided. There are about 400 male instances of breast cancer annually.
As healthcare professionals, we are aware that a comprehensive understanding is essential to enhancing patient care and results. Physical therapy is becoming a more common component of surgical rehabilitation in the UK, but patients typically have to find a therapist on their own rather than having it provided as part of their recovery. As an experienced trauma practitioner, I am also well equipped to manage this. If necessary, I may provide additional modalities to lessen the activation of the sympathetic nervous system and aid reduced anxiety.
Throughout history, women's breasts have been associated with various connotations, which can negatively impact their self-esteem and body image if they don't meet the ideal standard. The rise in breast augmentation surgeries in recent years, men's ignorance about breast cancer, and growing awareness of nursing are all clear examples of this philosophy. Historical and contemporary views about female breasts have influenced gender roles and the fulfilment of women's sexual desires.
However, society's widespread perception of breasts as exclusively sexual has led to a shortage of therapists offering breast massage. However, by releasing fascial restrictions, this therapy can help clients recovering from mastectomy with swelling, pain, and limited range of motion. Additionally, clients with breast cancer tend to hide their own emotions because they are more concerned with how their loved ones are handling the situation. They can confide in the massage therapist, let go of physical and emotional stress, and openly share their worries and anxieties. In this approach, clients can rediscover their individuality and feel empowered through energy work and oncology massage.
I believe that if the massage industry is to continue moving forward, we must not be afraid to challenge the boundaries imposed by society so that we can overcome stigma. Recognising the importance of training is crucial, as it equips therapists with the necessary knowledge to clearly demonstrate the need for breast massage in a sensitive and respectful manner, preventing it from being perceived as a sexual practice.
When should your breast symptoms be concerning?
Most of the changes in breast tissue that occur as we age are normal and not cause for concern, and self-examination of the breasts is recommended to identify such changes. When functional tissue converts to fat during menopause, usually after the age of 35, breast lumps naturally form as part of the involution process. Dense collagen replaces the lobe structures and eventually transforms into fat, and cysts, which may or may not be painful, are a common occurrence throughout this process.
Cyclic or non-cyclical mastalgia (breast pain) accounts for about half of breast-related medical consultations. However, lipid cysts, intramammary lymph nodes, abscess, haemorrhage, or duct ectasia, an inflammatory condition of the duct behind the nipple or areola, can cause other non-cancer-related symptoms.
Non-cancerous breast symptoms can also arise from issues involving some form of tissue overgrowth, such as fibroadenoma (lobular overgrowth), fibroadenosis (overgrowth of glandular epithelium), sclerosing adenosis (enlargement of lobules via epithelial proliferation), or even seemingly simple scar tissue or calcification. Fibrocystic alterations, the most common benign breast ailment, can cause pain and frequently result in needle aspiration. Usually a painless movable mass, fibroadenoma is a benign solid tumour that contains glandular and fibrous tissue. This can be concerning because a core biopsy, potentially accompanied by surgery, may be recommended, leading us to fear the worst.
The more visible symptoms, such as dimpling or orange peel skin, heat, redness, or skin sores, often indicate breast cancer. Changes to the nipple may also be observed, for example, crusting, discharge, or inversion. Any changes in the shape or size of the breast, growing veins, or lumps (particularly hard lumps) should be investigated.
A breast cancer diagnosis will cause a range of emotions. Patients frequently worry more about their loved ones' physical and mental wellbeing than about their own. Many cancer clients hide their anxieties because they care about others, and they often need someone to talk to, cry with, or touch them. A massage therapist can provide a safe environment where a client can relax, let go of physical and emotional stress, communicate worries and fears, and build resilience and strength for the road ahead.
Why is breast massage so important?
The general benefits of massage, such as promoting relaxation, reducing anxiety, boosting the blood and lymphatic circulation, improving skin tone, and easing muscle tension to aid soft tissue recovery after injury, all apply to any area of the body. Additionally, there are benefits specific to the breast, such as pain relief, maintaining the shape of the breast, breaking up benign cysts, and promoting milk production and flow, as well as unclogging clogged ducts during the postpartum and postnatal period. However, self-breast massage generally provides these benefits, serving as an effortless daily routine for monitoring breast health. It encourages lymphatic flow through the tissue, allowing for the detection of any changes or irregularities. However, the experienced hands of a professional breast massage therapist may be better equipped to detect any abnormalities in the breast tissue.
Massage therapists can greatly assist their clients in maintaining and promoting healthy breast tissue, raising awareness of tissue changes, and relieving the pain, swelling, and restricted range of motion commonly experienced by patients recovering from mastectomy or other breast surgeries.
Breast massage following mastectomy
As with any oncology massage, there would be a detailed consultation to fully understand the complexities of each individual case, and this would include discussion about the treatments that the client has undergone or will be completing as part of their cancer journey. Treatment options may include medication, chemotherapy, radiotherapy, or surgical procedures such as lumpectomy, lymph node dissection or removal, or mastectomy (total, radical, modified radical, partial, or subcutaneous). Additionally, if the client is undergoing reconstruction, this phase could involve simple implantation, the need for tissue expanders beforehand, or multiple donor sites in the case of flap reconstruction. Every treatment option brings its own set of challenges on top of those already experienced by each individual person. These challenges can also deter a therapist from offering therapy or make the client think that they cannot access it; hence, seeking an oncology-certified and experienced therapist is essential.
Extensive training is required for the variety of techniques used in a breast massage, making it a particularly accessible service. These techniques will include oncology massage, effleurage, myofascial release, muscle energy techniques, manual lymphatic drainage, scar tissue mobilisation, and cross-fibre friction. Most of these techniques do not come with standard massage training. Personally, I like to incorporate breathwork into my breast massage sessions, as it not only serves as a valuable modality for regulating the nervous system but also aids in relieving anxiety and treating medical PTSD. Additionally, it aids in the release of the diaphragm and accessory respiratory muscles, which is crucial after breast surgery. I also have the option of combining these modalities with reiki for a less invasive approach.
Massage during treatment cycles will always be planned, implemented, and re-evaluated in each individual case, offering relief from pain and nausea, reducing fatigue, and easing stress, anxiety, and depression, all of which also helps to improve sleeping patterns. One of the biggest benefits of oncology massage generally, however, is the impact it has on mental health, not only providing an objective person who will listen to the clients worries without the feeling of burden that can sometimes come with attachment, but also working around the heart chakra can promote feelings of self-love and compassion, which in turn can help recover lost identity, femininity, and a sense of purpose.
After surgery, however, the benefits continue, bridging the gap between surgical intervention and post-operative rehabilitation by assisting with tissue healing, releasing fascial restrictions to increase range of motion, and helping to prevent capsular adhesions. Inclusion of lymphatic and scarwork techniques not only addresses any issues with post-operative oedema but also contributes to minimising scar tissue formation through healthy realignment, which improves outcomes for those with radiation fibrosis.
Summary
Considering an in-depth consultation to identify precautions such as hypersensitivity and skin fragility following radiotherapy, I firmly believe that breast massage is a valuable addition to post-surgical care, helping not only physically but also mentally and emotionally. This article discusses how a client can feel safe and reassured about receiving breast work in a relaxing treatment room, an environment that can easily integrate into a full body massage. The same guidelines apply to informed consent, but we advise obtaining specific written consent from a client for breast work, allowing them more time to consider their decision before proceeding with the actual session. It also goes without saying that in the event of an irregularity being noticed during the massage or disclosed by the client, liaison with the oncology team should take place. With oncology consultants coming aboard the breast massage train, all that is left to do is challenge the social perceptions about breasts and cancer that often lead to misconceptions about massage input.
Read more from Sam Mishra
Sam Mishra, The Medical Massage Lady
Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology and lymphatic practitioner, trauma practitioner, breathwork facilitator, reiki and intuitive energy healer, transformational and spiritual coach and hypnotherapist. Her medical background as a nurse and a midwife, combined with her own experiences of childhood disability and abuse, have resulted in a diverse and specialised service, but she is mostly known for her trauma work. She is motivated by the adversity she has faced, using it as a driving force in her charity work and in offering the vulnerable a means of support. Her aim is to educate about medical conditions using easily understood language, to avoid inappropriate treatments being carried out and for health promotion purposes in the general public. She is also becoming known for challenging the stigmas in our society and pushing through the boundaries that have been set by such stigmas within the massage industry.
References:
Bonillas, C. (2009). What people think, feel, and want to know about breasts. In E. Schroeder & J. Kuriansky (Eds.), Sexuality education: Past, present, and future, Vol. 2. What people want to know (pp. 87–107). Praeger Publishers/Greenwood Publishing Group.
Cole JS, Olson AD, Dupont-Versteegden EE.(2024) The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients With Breast Cancer: A Systematic Review and Meta-Analysis. Global Advances in Integral Medicine & Health. Apr 16;13
Massingill J, Jorgensen C, Dolata J, Sehgal AR. (2018) Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery. International Journal of Therapeutic Massage Bodywork. Aug 5;11(3):4-9
Walker, S., Hyde, C. & Hamilton, W. (2014) Risk of breast cancer in symptomatic women in primary care: a case–control study using electronic records. British Journal of General Practice 64 (629): e788-e793
