Proposed Changes to Regulations on Breast Massage in Washington State

I am writing to let everyone know about proposed changes in the Washington Administrative Code (WAC) regarding breast massage in Washington State. This year the WAC for massage therapy is being reviewed and updated - in its ENTIRETY. This is a big undertaking. The Board of Massage for the Department of Health is meeting every eight weeks for the next year to see this completed mid 2016. The Board is proposing a new section of the code specifically delineating the do’s and don’ts of breast massage. Proposed changes will include requiring separate written consent for treating breast tissue and undraping the breast, offering a chaperone to be present during the treatment, having a written prescription prior to working on the nipple, and maintaining records documenting training for massage to the nipple.

A written copy of the proposed changes was circulated at the meeting on May 8th. Reviewing this draft, I felt it was not in the public’s best interest to have a training requirement for massage therapy to the nipple, but not the rest of the breast. I know of one primary massage school in Washington State that includes any breast massage as part of its curriculum. This is a service that is sorely needed by women with breast health issues, but needs to be performed with adequate care and competency. Currently, the vast majority of massage therapists have no training in breast anatomy and breast massage. It would be a shame to do all the work of addressing this service in the WAC and then have it misused or misunderstood. Thus, I am sending this letter (below) to the Board of Massage. You are welcome to copy it and personalize it for yourself. Megan Brown is the Program Manager for the Board of Massage and she welcomes input from everyone. Her email is The next meeting is July 10th at 9am in Tumwater, WA.

Dear Board Members, I am writing to propose that subsection 3-a of proposed draft rules WAC 246-830-xxx on Breast Massage be moved to subsection 1-e of the same rule. As it is currently proposed, additional training beyond primary massage education, would only be required for areola treatment, but not required for massage of the rest of the breast.

Women in many different phases of life, from lactation and wellness, to surgery and oncology, will be seeking this service. This is a highly specialized arena in women's health and, thus, requires a high level of experience and maturity. Depending on a therapist's area of expertise, this training might include extensive study of oncology massage, obstetrical massage, lymphatic massage and/or surgical massage, in addition to specialized breast care training.

I regularly practice breast massage with my clients, as well as teaching continuing education classes in breast care, so I may be considered biased. But my experience with massage students is that there is a complete dearth of training on the topic of breast anatomy, physiology, and pathology in primary massage schools. Personally, I had to travel all over the country to find high level training in breast massage. I put forth this effort because this treatment is so beneficial for relieving breast health issues.

Breast massage should be readily available for women experiencing breast pain, engorgement, breast cancer, and post-surgical scarring, as well as for wellness and spa massage. But not without advanced training. It would be a terrible loss for a woman to avoid these healthful services because she was treated inappropriately by someone who was not familiar with the issues involved in treating this delicate tissue.