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Breast cancer is the most common cancer among women in the United States, and is the second-leading cause of death in women. Each year, more than 180,000 women are diagnosed with breast cancer. With these sobering statistics, the likelihood of encountering a client with breast cancer also increases.
This article presents an overview of breast cancer and breast surgeries, explores the physical and psychological impacts of surgeries on clients, and describes a few simple, yet highly effective techniques that may be beneficial when working with mastectomy clients. Legal issues, client intake forms, and marketing strategies and other resources are addressed.
Background And History Of Breast Cancer
Breast cancer surgery dates back to the 1600s, when Wilheim Fabry, the
"father of German surgery" developed a special forcep for amputating a cancerous breast. The instrument constricted the base of the breast while a blade swept the organ off the chest wall. Enlarged lymph nodes also were excised.
Physicians in the mid-19th century viewed breast cancer as arising in one location. If left untreated, it would spread through the lymph system to distant nodes, sites and organs. This led to the theory of the radical mastectomy, or the surgical removal of all the breast tissue, underlying chest muscle and lymph nodes before the cancer could spread.
Dr. William Stuart Halsted developed this radical surgical procedure, the
"Halsted Mastectomy." First performed in England in 1857, this procedure was the surgical standard for more than 60 years. Even today, more than 100 years later, this surgery continues to be a choice for some women with advanced cancer. Depending on the staging and location of cancer, a more modified partial mastectomy or lumpectomy may be performed. The first modified radical mastectomy was performed in the 1940s.
In 1930, the medical profession began using radiation to alter the DNA of cancerous cells, preventing them from multiplying and spreading to distant sites, while shrinking the tumorous growths.
In 1943, the first chemotherapeutic agent a combination of plant antibiotics and nitrogen mustard compounds
was used at Yale New Haven Medical Center. Today, about 80 chemotherapy drugs are used. Although a single drug can be used to treat cancer, chemotherapy drugs usually are more powerful when used in combination with other drugs.
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. Remember that your 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!
Preoperative Tips
Because of the physical impact of breast surgery we have found in our practice that, when possible, we encourage clients in our practice to consider the
"Three Massage Rule." That is, three massages (bodywork sessions) administered preoperatively to help prepare the women physically and emotionally for surgery. This is an ideal plan! However, in most cases we are able to see a client only twice, or sometimes even once.
The number of sessions will depend on the surgical schedule of the client, and the content will depend on the physical and emotional status of the woman prior to surgery. For example, clients who have been receiving regular massage may have a greater need for energy balancing rather than deeper therapy. What modality is used, depends on the needs of the client at that time. There is no set order to the routine. Remember, it's important to listen to the client and offer them what they need.
If you are able to see the client three times, one of the three sessions might cover the physical aspects including myofascial release, trigger-point therapy, Amma therapy, or a Swedish-based massage with a gentle, soft, nurturing touch. A subsequent session may cover an energy balancing technique such as craniosacral, reiki, polarity, therapeutic touch, Trager therapy, or Jin-Shin Jyitsu. A third session may include a gentle touch such as manual lymph drainage
(MLD).
It's very possible that a presurgical session may consist of simply listening, as you may be the only one to whom the client can relate their fears, concerns and feelings. In this case, being there and allowing the client to share may be all that you do.
It's important to remember, above all else, that your client has cancer! Any client who is in the acute phase of their therapy, (e.g., in active treatment via surgery, chemotherapy and/or radiation with continued monitoring by their physician) should have the length, depth and speed of the massage routine adjusted to their needs.
Along with that diagnosis is the most obvious physical impact É the surgical amputation and loss of a breast. Accompanying emotional and psychological impacts can include fear of loss of loved ones and family, disconnect from self, denial, anger, and all of the accompanying emotional and psychological implications.
The goal is to help the women feel connected to her body, since she may feel disconnected.
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