New Rules: Breast Massage
By Dagmar Growe, LMT
Hopefully, you are aware that starting July 30, 2017, breast massage requires a separate special consent and additional training (see the full WAC). Who needs more paperwork, right? It might be helpful, though, to take a step back and look at the bigger picture for a moment. First of all, this means that massaging breasts is clearly included in our scope of practice. While there has never been any discussion to the contrary, we also might not want to take this for granted - it’s not true for every state in the US (see www.lomilomimassage.org for a list of state regulations).
Secondly, it’s important to remember that these rules are created in response to complaints filed with the Board of Massage by clients and (this one blew me away) family or friends of clients. Not every complaint about inappropriate touch involves a therapist who had intent to touch inappropriately. So these rules are not just about protecting clients, they are also about protecting ourselves.
Over the years I have had a few women ask me about breast massage. The stories they told usually involved a therapist who, without warning, pulled back the sheet, and proceeded to glide his hands over the woman’s breasts. The client, surprised or shocked, tried to talk herself into accepting this as a “normal” part of the treatment that she “should” feel comfortable with. Needless to say, it always turned into a lose - lose situation: The client did not feel relaxed, never returned to the therapist, and in the future, with some hesitation, would ask for a female therapist. No telling how many gave up massage. And, to be clear, this is how I was taught to perform breast massage back in the early 90’s.
As massage has become a mainstream medical modality in our state, there is even more need to be sensitive to people’s diverse levels of comfort with touch. The new rules lay out a process of safe touch which may be helpful for clients and therapist alike.
If all of us follow this process, it will accomplish a number of important things:
These benefits are well worth the extra paperwork!
Breast Massage - The Details
Massage therapists are required to “maintain evidence of the completion of at least 16 hours of specialized in-person education and training in breast massage ...” - WAC 246-830-555 (2). This is not an endorsement like the one for intraoral massage - we just need to have proof of this education in case we get audited.
The Breast Massage rule has 3 different types of consent to consider:
Breast Massage requires a written consent which must be kept with the patient’s records. While the rules are not specific on this, discussions at board meetings indicate that the written consent can be obtained once, but verbal consent should be obtained at every session, and noted in the treatment records. The consent has to include a statement that the patient can discontinue the treatment at any time for any reason. Patients have the right to have a witness present during the treatment, and minors require consent from a guardian.
Massage of the areola and/or nipple requires either a prescription by a licensed health care provider or an additional written and verbal informed consent. It’s important to note that “informed” is a legal term defined by case law. It requires that very specific information be given to the patient: 1. Why the treatment is necessary, 2. detailed information about what the treatment entails, 3. if there are other options,4. what side effects could happen, and 5. what the consequences of not treating might be.
Draping is an issue separate from the breast massage itself (and we will have a separate article on it in the future). Breasts are required to be covered during a massage (and yes, that includes men), unless a written and verbal informed consent is being obtained prior to undraping. So just because someone consents to breast massage does not mean they have agreed to having their breasts uncovered. Also, the draping rules require that the therapist note, in the treatment records, the rationale for the draping variance.
Another issue to consider is the definition of “breast”. WAC 246-830-005 (7) defines breast massage as “the specific and deliberate manipulation of breast tissue” and specifies that massage of pectoral or axillary muscles is not considered breast massage. However, this rather technical distinction might be lost on some patients who might be uncomfortable with any touch in the area of their breast. Therefore, the consent form on the WSMTA website includes a section that asks for a separate consent for work on tissues around or near the breast. The intent is to open a conversation, and to give the client an opportunity to voice any concerns.
One last issue that is not directly related: I used to naively assume that if someone scheduled an appointment for a massage and walked into my office this would constitute a consent to receive a massage treatment. It does not, according to the law. A signed “general consent to treat” (per WAC 246-830-565 (1) (g)) needs to be on file with the patient's treatment records.
board of Massage has recently started another cycle of rule revisions.
Rules relating to breast massage will be discussed at the board meetings
on May 11, 2018 and July 13, 2018, together with the rules regarding
perineal massage. If you have any input please submit it to the board in
writing prior to the meetings, and consider attending the meeting.
(Find meeting dates/time on the BOM website)
Thanks to Aubrey Lesicki or www.breastremedyseattle.com for her excellent class on breast massage and the new rules, which provided valuable content for this article.
For a sample consent form specifically for Breast massage visit: www.BreastRemedySeattle.com