Radiation
While client is undergoing radiation, the affected areas should not be touched until after touch is tolerated by the client. This area is similar to a bad sunburn. Covering the breast with a soft cloth is suggested, as a heavy covering or towel may cause additional discomfort to the area. A combination of calendula, St. John's Wort, arnica, and comfrey ointment, administered frequently before and during the radiation phase, has been shown to prevent and reduce the effects of burning. Refrain from using heat or cold packs. As with chemotherapy, deep pressure is to be avoided to prevent bruising or possible fractures.

Massage Techniques For Mastectomy
The methods that are listed here are most often effective when used on women being treated for breast cancer. They are: 1) basic massage strokes except deep tissue; 2) myofascial softening and spreading; 3) acupressure/trigger point-modified; 4) manual lymph drainage; and 5) cross-fiber frictioning and skin rolling, for scar tissue release.

Positioning Guidelines
Positioning should always be based on the comfort of the woman. For a new or fresh mastectomy, ask client to position her arm comfortably on her own, as this is the best indicator of comfort and mobility. The arm should be supported with a small pillow under the forearm and elbow.
 
For two weeks post-surgical and forward, the woman should be worked on in the supine position, or side-lying position with the operative side up, comfortably supported with the Body Support Cushion System or pillows. Do not ask your client to assume the prone position until she reports being able to sleep on her stomach. At that point, the specially-designed Body Support Breast Cushion is used in our practice. 
 
For the client who has just had a TRAM, be certain that the client is supine, with the knees flexed and bolstered in an elevated position to reduce any stress on the abdominal incision.

Techniques Specific To The Breast And Shoulder
This section is not intended to be a complete protocol, and only presents a few examples of simple, yet effective techniques.
 
Myofascial softening, spreading and circular compressions on the pectoral region using the back of the hand. The hand is kept open, relaxed in the prone position. This will enable the therapist to safely and gently touch the breast tissue without being invasive to the woman. Fingers and fingertips limit accessibility onto the breast tissue. The back of hand position is most effective when used in the axillary area. Refrain from digging fingers into the axilla. 
Frictioning of sternum and intercostals. Begin at sternoclavicular joint and above the xiphoid process. This move will release fascia, connective tissue and trigger points.
 
Thumping of the clavicle, sternum and thymus. Shoulder Traction and Side Pulls. Stand on opposite side to be worked on, cradle shoulder with both hands and slowly draw shoulder up and over, perpendicular to the table. Hold and stretch a minimum of 30 seconds. Continue this movement slowly, down the thoracolumbar region to the lumbar spine. Repeat on other shoulder.
 
Racking of Rib Cage combined with shoulder traction/side pulls. Sculpting of Rib Cage and Diaphragm. Stand on opposite side to be worked on, with upper hand, pinky side down, forming a knife edge, on the lower ribs (e.g., ribs 8 to 10) will provide skin slack. Ask client to inhale. Upon client's exhalation, the lower hand, beginning at the end of the xiphoid process will sculpt under the ribcage and diaphragm. This should be done a minimum of three times each side.
  
TALO Sweep (Tricep Axillary, Latissimus, Obliques). Begin back of hand movement on tricep and sweep down to axilla, latissimus dorsi, and begin movement up from obliques back to axillary area.
  
Angel Wing Fluff. Gently place both hand in flat position on the medial border of the scapula. Gently and slowly move fingers to mobilize the scapula. Movement resembles fluffing a pillow.
  
Conclusion
Any touch administered to a woman who has experienced the devastation and trauma of breast cancer surgery can be effective. Each woman heals at her own rate and the therapist should be sensitive to the physical, psychological and emotional dynamics at hand. It matters not whether the touch is technically or energetically administered, as long as the intention of the therapist is not to fixÑbut to empower the women to reclaim her self again.

Cheryl Chapman, RN, HNC, NCTMB, integrates both holistic nursing and massage into her work. She has a private practice in Springfield, New Jersey, and specializes in touch, bodywork and massage for people with cancer and mastectomies. She is a pioneer in promoting massage for people with cancer, and maintains an active teaching schedule instructing practitioners nationwide. 
 
Eileen Kennedy, MA, MBA, NCTMB, APP, shares a private practice with Chapman, providing research support in the development and administration of massage teaching programs. She has more than 20 years experience in the pharmaceutical sector. She actively integrates therapeutic touch and her certification in polarity therapy into her work with cancer and breast surgery clients. Both can be reached at: 973-912-9060, or via E-mail at: touch2RN@aol.com. 
 
Bibliography
Stein Henderson, Jaclyn. "Approaching The Client With Breast Explanation Syndrome." Massage & Bodywork Magazine, Summer/Fall 1997.
 
Chamness, Annette. "Breast Cancer And Massage Therapy." Massage Therapy Journal, Winter 1996.
 
Curties, Debra. "Could Massage Therapy Promote Cancer Metastasis?" Journal of Soft Tissue Manipulation, April/May 1994.
 
Berger, Karen, and John Bostwick, III. A Women's Decision: Breast Care, Treatment, And Reconstruction, 2nd 
Edition. St. Louis: Quality Medical Publishing, Inc., 1998.
 
MacDonald, Gayle. Medicine Hands: Massage Therapy For People With Cancer, Tallahassee, Florida: Findhorn Press, 1999.
 
Chamness, Annette. "Massage Therapy And Persons Living With Cancer." Massage Therapy Journal, Summer 1993. 
 
Curties, Debra. Massage Therapy 
And Cancer, Moncton, New Brunswick: Curties-Overzet Publications, 1999.
Nelson, Dawn. Compassionate Touch. Barrytown, New York: Station Hill Press, 1993.
Walton, Tracy. "Contraindications To Massage Therapy."  Massage Therapy Journal, Summer 1998.
 
Love, Susan. Dr. Susan Love's Breast Book. New York: Addison Wesley, 1995.
Northrup, Christiane. Women's Bodies, Women's Wisdom. New York: Bantam Books, 1998.
 
Resource List
 
Organizations
National Alliance of Breast Cancer Organizations, New York City: 212-889-0606
National Cancer Institute (NCI), Bethesda, Maryland: 800-4-CANCER (800-227-2345); [www.cancer.gov]

American Cancer Society: 800-ACS-2345 (800-227-2345)
 
Hospice Association of America: 800-232-3442
 
The Susan G. Koman Alliance: 800-IM-AWARE (800-462-9273)
 
Y-Me Breast Cancer Support Group, Chicago: 800-221-2141
 
National Lymphedema Network and Hotline, San Francisco: 800-541-3259
 
Cancer Care, Inc., Services: 212-302-2400; 800-813-HOPE (4673); [info@cancercare.org]
 
Other Sources
Ellis, Coni. "Breast Reconstruction After Mastectomy." Oncolink, University of Pennsylvania Cancer Center [www.cancer.med.upenn.edu/disease].
 
Beinfield, H. "Revisiting Accepted Wisdom In The Management Of Breast Cancer." Alternative Therapies in Health and Medicine, September 1997.
 
Rotter, J. "Development Of Surgery For Breast Carcinoma." Zentralblatt fur Chirurgie (Germany), English Abstract, 1997.
 
McAllister. Cancer. New York: Basic Books, 1993.