In recognition of Breast Cancer Awareness Month, I offer this post on breast health as it relates to massage therapy.
Women’s breasts are symbolic of femininity, sexuality, and the ability to nurture children. This symbolism, and the experiences and sensitivities that result from it, can cause us to overlook the fact that breasts are body tissues with unique needs not unlike our other body tissues.
Breasts are composed of adipose (fatty) tissue that surrounds glandular tissue. The glandular tissue is activated by hormones and is responsible for milk production that occurs in late pregnancy and after childbirth. In the adult female breast, the glands are composed of groups of mammary lobules that make and hold breast milk. Around the lobules are ducts that funnel the milk to the surface. The ducts come together near the aureole, the darken circle surrounding the nipple. The structure of the male breast is nearly identical to that of the female breast, except that the male breast tissue lacks the specialized lobules, as there is no physiologic need for milk production by the male breast.
Anatomically, the adult breast sits atop the pectoralis muscle (the "pec" chest muscle), atop the ribcage. The breast tissue extends horizontally (side-to-side) from the edge of the sternum (the firm flat bone in the middle of the chest) out to the mid-axillary line (the center of the axilla, or under arm). It is important to note that a tail of breast tissue called the "axillary tail of Spence” does extend into the axilla.
The breast tissue is encircled by a thin layer of connective tissue called fascia. The deep layer of this fascia sits immediately on top of the pectoralis muscle, and the superficial layer sits just under the skin. The skin covering the breast is similar to skin elsewhere on the torso and has similar sweat glands, hair follicles, and other characteristic features. Underneath the pectorals muscles are other important anterior chest muscles such as serratus anterior, the intercostal group (ribs), and the superior aspects of rectus abdominis (abdominal area). These muscles are often implicated in shoulder posture problems, breathing restrictions, abdominal and hip concerns.
One of the most important structures within the breast tissue for maintaining its health is a network of lymphatic pathways and lymph nodes. These structures are responsible for draining excess interstitial fluid from around the cells and carrying out immunological responses. Within the lymph nodes are mini factories that create lymphocytes (white blood cells). These specialized cells have the ability to recognize foreign and abnormal cells, microbes, toxins, even cancer cells, engage them with a resistance response, neutralize and eliminate them from the body. The lymphatic vessels in the breast tissue are imbedded within the adipose tissue. The majority of the lymphatic vessels move their contents called lymph laterally to the lymph nodes in the axilla, while a smaller amount moves the lymph to the parasternal nodes near the sternum.
Breast tissue is unique as it’s the only area of the body other than the brain that is not surrounded by muscular tissue. Because the adipose tissue in the breast is external to muscular tissue, they lack sources of adjacent compression to promote the natural movement of lymphatic fluid and blood. This natural movement is further suppressed by the extensive use of undergarments that do not allow breast tissue to move freely. In addition poor posture may also play a role in diminished lymphatic movement. When lymphatic movement slows down, the regeneration of cells becomes less effective allowing toxins and proteins to accumulate around the cells in the breast. This accumulation is the basis for one of the leading theories concerning the formation of breast abnormalities and pathologies outside of family genetic history.
Breast abnormalities and pathologies have gained a lot of attention in recent years due to the rise in malignant breast disease (cancer) and the advanced technologies that are used to detect and treat them. According to the Cosmetic Surgery National Data Bank Statistics which were published by the American Society of Aesthetic Plastic Surgeons, over 7 million Americans have some form of breast tissue abnormality. Also data provided by the Mammography Saves Lives website indicate that 10 % of women will have an abnormal mammogram this year; most of these will be followed up with additional images and needle biopsies. According to the American Cancer Society (cancer.org), 231,000 new cases of invasive breast cancer will be diagnosed this year in the United States, about one in eight women. In addition, 62,280 new cases of non-invasive (in situ) breast cancer will be diagnosed. Sadly, about 40,170 women in the U.S. are expected to die from the disease. Although not as prevalent, breast cancer does affect men too. The good news is that, about 2.5 million women in the U.S. have survived breast cancer. In addition, women with breast cancer can suffer from depression, anxiety, and stress, which can result in a decreased in natural killer (NK) cells. A drop in NK cell activity has been linked to increased tumor development.
The benefits of Massage therapy in general are well known to patients suffering from cancer treatments. Performed by a skilled and qualified therapists, the immediate benefits of massage therapy include reduced stress and anxiety. Long-term massage effects include reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes. 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. A another 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).
But, specifically for breast tissue there is a specialized form of massage therapy called Manual Lymphatic Drainage that is increasing being used in the oncology setting in the United States and is becoming an integral component in patient treatments. Manual Lymphatic Drainage or MLD is a gentle non-invasive technique that increases the amount of lymph and interstitial fluid processed by the body. It was developed in France by Emil and Estrid Vodder in 1932 and has grown to be the most well-known manual technique to assist in lymph flow and drainage of tissues.
MLD therapy on breast tissues can assist with post-surgical recovery, reducing inflammation and edema, pain control, local infection prevention, hematoma resolution, as well as help patients manage lymphedema. MLD can also be helpful for clients/patients that have fibrocystic breast disease (irregular benign lumps, swollenness, discomfort or pain, or a feeling of fullness in the breast tissue)
How is Manual Lymphatic Drainage Performed on Breast tissue?
MLD is performed along the path of the lymphatic channels in the direction of lymph flow from the surrounding tissues of the breast through the regional lymph nodes to the termination junction with the circulation system. The treatment proceeds in four phases:
1.) Prepare the supraclavicular fossa to receive increase lymphatic flow at the circulation termination junction.
2.) Lymphatic clearing of the efferent vessels at the regional lymph nodes.
3.) Lymphatic clearing of the afferent vessels in the breast and surrounding tissues that feed into the regional lymph nodes.
4.)A final clearing of the entire lymph network of the anterior chest concludes the treatment.
Cancer Treatments can be very complex, so the MLD therapist will always consult with the patient and their medical team to make sure what form of the MLD protocol is most beneficial at what stage of their treatment. Cancer patients interested in adding MLD therapy or regular massage to their health wellness plan or recovery should consider the following:
- patients should consult with their oncologist or personal physician for recommendations.
- Massage protocols for cancer patients need to be customized. It's important to let your massage therapist know about your diagnosis, treatment, and any symptoms you may have. Treatment plans vary from patient to patient and from session to session for the same patient.
- Massage during cancer treatments needs to be performed using an oncology massage protocol that fits the current situation of the patient. Some of the factors that need to be considered are the type and severity of the cancer, locations of the surgery or treatment in the body, the cancer therapy being administered (surgery, radiation, chemotherapy, etc.), the timetable of the treatments or therapy, the effects on the lymphatic system, and side effects or other symptoms that the patient is experiencing.
- Cancer patients that are at risk for lymphedema or where lymphedema is already present should consult with a massage therapist trained and certified in manual lymph drainage as well as oncology protocols.
To find a qualified massage therapist in your area, visit these organizations: