legalities of chest & breast massage in the usa
 

disclaimer & request

The information on this page comes from my personal research done via the internet, and may not always be complete.  Note the dates and be aware that the laws could have change since I collected the information.

If you find additional information, or updated information, please send it to me via my contact me page.

~ Barbara Helynn Heard

 

overview of breast massage regulations in the USA, 2016

Therapeutic, full chest and breast massage to support wellness and/or as treatment for medical conditions is currently legal in about 75% of the states within the USA.  Breast massage used only to treat medical conditions is legal in several additional states.  The client must consent to this treatment.

24 states have no specific regulations for massaging or draping breast tissue*. Therapeutic massage of the full breast is therefore at least not illegal.  (Breast massage is, however, subject to all general massage rules such as those requiring appropriate training and avoiding sexual contact.)
AK, CO, CT, FL, GA, HI, ID, IL, IA, ME, MD, MA, MI, MT, NE, NJ,NM, ND, OH, OK, RI, SD, DC, WI

14 states have rules which specifically allow therapeutic massage of the full breasts, not restricted to medical issues:

  • 1 state allows breast massage consistent with community standards of practice: WA
  • 3 states allow breast massage with informed consent: NH, NY, NC
  • 5 states allow breast massage with written consent: AZ, MI, PA, TX, UT
  • 1 state allows breast massage with written consent when client and therapist are the same gender: TN
  • 3 states allow breast massage with written consent and education: IN, KY, OR
  • 1 state allows breast massage with written consent and plan of care:  WV

1 state allows partial breast massage with written consent.  Touch of nipples and areola prohibited. NV

1 state allows full breast massage with prior written consent and/or physician referral, but requires physician referral for medical issues: SC

3 states restrict breast massage to medical issues and/or always require referral

  • 1 state allows breast massage with written consent and referral:   CA
  • 1 state allows breast massage for treatment of scar tissue, myofascial binding & lymphatic flow only, with written consent & 48 hours education: AR
  • 1 state allows breast massage with physician referral or by documented clinical indication, advanced training required: MO

1 state restricts touch of nipples and areola to clients with medical condition  and referral: VA

3 states require the breasts to always be draped.  They do not have specific breast massage rules.   AL, DE, LA

4 states are not licensed – individual towns, cities or counties may have rules: KS, MI, VT, WY  

NOTES:
The list total 51 states because Washington DC is included on the list.


breast massage regulations in the usa: details

ALABAMA
breasts must always be draped.
no specific breast massage regulations*

Sources of information:
Home page: http://www.almtbd.state.al.us/
Rules & regulations: http://www.almtbd.state.al.us/PDF/Rules/2014_MAS_Rules_Regulations.pdf

text from the law/rules:
Breast Massage: no reference to breast massage
Draping: breasts and buttocks must be covered at all times
“Each massage therapy establishment must demonstrate…..clean drape material for draping clients during the massage, use of which shall be explained to the client prior to the massage, and which shall cover the buttocks and genitals of a male client at all times during the massage, and which shall cover the buttocks, breasts, and genitals of a female client at all times during the massage.”

information updated: 7/20/16

ALASKA
no specific breast massage regulations*

Sources of information:
https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofMassageTherapists.aspx

text from the law/rules
Breast massage:
There is no specific info on breast massage in the statutes & regulations, or in the code of ethics.

Draping: “I will respect the client’s autonomy by providing draping and treatment in a way that ensures the safety, comfort and privacy of the client.”  - within the code of ethics

communication with the Alaska Board of Massage Therapists
2016/07/20: I emailed at randy.brown@alaska.gov to ask if they have rules about breast massage  now, or if they are in the process of writing such rules. email sent to:  randy.brown@alaska.gov.  

I received this reply: "I am not aware of any state laws on these issues outside of the statutes and regulations found on the Board of Massage Therapists web page at https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofMassageTherapists.aspx.  The board is not actively writing any regulations on this topic, and I am not aware of a lobby to our state legislature to amend state law."

information updated: 7/20/16

ARIZONA:
breast massage allowed with written consent

sources of information:
https://massagetherapy.az.gov/statutes-and-rules   32:4253 disciplinary actions  (breast massage)
https://massagetherapy.az.gov/statutes-and-rules/R4-15-103 (draping)

text from the law/rules:
breast massage:
illegal: “ Massaging, touching or applying any instrument or device by a licensee in the course of practicing or engaging in massage therapy to the breasts of a female client unless the client requests breast massage and signs a written consent form. If the client is a minor, the consent form must include the signature of the client's parent or legal guardian authorizing the procedure and outlining the reason for the procedure before the procedure is performed.”
Draping:
1.    "When a licensee agrees to provide massage therapy to a client, the licensee shall:……Provide draping that ensures the safety, comfort, and privacy of the client;"

information updated: 7/20/16

ARKANSAS
Breast Massage allowed for treatment of scar tissue,  myofascial binding & lymphatic flow only ~ with written consent & 48 hr education

sources of information:
http://www.healthy.arkansas.gov/programsServices/hsLicensingRegulation/MassageTherapy/Pages/default.aspx
massage therapy laws: http://www.healthy.arkansas.gov/programsServices/hsLicensingRegulation/MassageTherapy/Documents/MassageTherapyLaw.pdf
massage therapy rules and regulations: http://www.healthy.arkansas.gov/aboutADH/RulesRegs/MTB.pdf

text from the law/rules:
breast massage: from the “law” document:
(2) The committee shall revoke the license of a person who engages in the practice of massage of the breasts unless the massage therapist:
(i) Engages in the practice of massage of the breasts for therapeutic and medical purposes including without limitation the reduction of scar tissue following a surgery on the breast, release of myofascial binding, or improving lymphatic flow; and
(ii) Has received at least forty-eight (48) hours of continuing education credits in lymphatic massage, myofascial massage, or oncology massage.

breast massage: from the “rules” document: under article 9 “draping and guidelines”
5. The breast of a female client may be treated only if there is a valid health maintenance request from the client or upon being presented with a prescription or referral from a qualified medical professional.
a. A female client’s breast may not be exposed without first having obtained her prior written, signed consent.
b. A written description and explanation is to be given before the massage begins and permission granted again before uncovering the breast.
1. Treatments must be noted on the client's assessment form.
6. The Board shall revoke the license for a period of three years of a licensee who engages in the practice of massage therapy of the breast tissue unless:
a. Documented clinical indications or a physician prescription shall be required and this documentation shall be included in the client’s records.  Breast Tissue massage shall only be done for the reduction of scar tissue following surgery, releasing myofascial binding or improving lymphatic flow.
c. A massage therapist shall have a minimum of forty-eight (48 CEU) hours in advanced training in techniques related to therapeutic treatment of breast tissue in lymphatic massage, myofascial massage, or oncology massage.

Draping: from the rules document:
Draping and treatment are provided in a way that ensures the safety, comfort, and privacy of the client and therapist.
2. Both the client and the therapist require that draping takes place during the massage, and the therapist will comply with the client’s request to remain partially or fully clothed under the drape.
3. Clients receiving a massage must be draped to assure that the pubic area and genitals are not exposed.

information updated: 7/20/16

CALIFORNIA
Breast massage allowed with written consent and referral  

sources of information:
note: state level voluntary certification for massage professionals.
https://www.camtc.org/
Massage Therapy act: https://www.camtc.org/FormDownloads/massage_therapy_act.pdf

text from the law/rules:
breast massage:
4609. (a) It is a violation of this chapter for an applicant or a certificate holder to commit any of the following acts, the commission of which is grounds for the council to deny an application for a certificate or to impose discipline on a certificate holder: ….
(F) Providing massage of female breasts without the written consent of the person receiving the massage and a referral from a licensed California health care provider.

Draping:
51034. …(c) Nothing contained in this chapter shall authorize a city, county, or city and county to do any of the following: ….  (4) Impose client draping requirements that extend beyond the covering of genitalia and female breasts, or otherwise mandate
that the client wear special clothing.

information updated: 7/20/22

COLORADO
no specific breast massage regulations*

sources of information:
https://www.colorado.gov/pacific/dora/Massage_Therapy under department of professions and occupations  - other medical professional such as DC, PT and more are also covered here
https://www.colorado.gov/pacific/dora/Massage_Therapy

email correspondence with the Colorado Massage Therapy licensing office: see bolded, large response below

summary:
Colorado has  no specific breast massage or draping rules. The licensing department responds to complaints and could discipline a therapist if, in their opinion, the draping used, or the breast massage done, was  a sexual act, or was "an act that does not meet, or failed to perform an act necessary to meet, generally accepted standards of massage therapy care."

text from the law/rules:
massage therapists practice act (in a pdf) – no specific mention of draping.  The only specific mention of breasts is in the Massage Therapy Act 12-35.5-111 grounds for discipline section q which identifies the act of a therapist baring intimate parts of their own body in front of a client.  (As of 8/18/16, Section Q has been approved but not yet published.)
massage therapist licensure rules and regulation (in a pdf) - no mention of draping or breasts

communication with the Colorado regulators:  https://www.colorado.gov/pacific/dora/Massage_Therapy_Program_Info

2016/07/20 – I emailed them to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules  dora_massagetherapists@state.co.us  
I received this reply from dora_massagetherapists@state.co.us    
Hello Ms. Heard:
Grounds for discipline are defined by the massage therapy practice act (§ 12-35.5-111, C.R.S.).
 
Poor draping would fall under (o) and (q) violations. Breast massage would constitute sexual contact, a (b) violation. The (q) violation is new, added by the recent bill and is not yet on the website (probably not until the new laws are published in August.)

Thank you and please let us know if this helped!


On 7/22/16 I replied to this email with request for further clarification:

Thank you for your prompt response.
1)  Please tell me how the newly-drafted-not-yet-published item (q) under the grounds for discipline reads.
 2) The laws you sent me all refer to sexual touch. ... Therapeutic breast massage is  done with therapeutic intent and with therapeutic touch; it does not involve sexual intent or sexual touch.  Therefore, as I read the law, therapeutic breast massage is legal.
 However, you wrote, "Breast massage would constitute sexual contact, a (b) violation."  Would you please clarify if your intention is to state that all breast massage is considered a sexual contact, or only that done without therapeutic intent, and with sexual intent.
 
Thank you for your help.
Barbara Helynn Heard

On 8/18/16 I received this response:

Ms. Heard,

Unfortunately, I cannot make a blanket determination regarding therapeutic breast massage. However, you should understand that our enforcement of the Massage Therapy Practice Act is complaint driven. That means an investigation into your practice would only take place if a complaint is filed against you. And in that case the complainant would dispute the intent of the touch. We would then investigate and decide if disciplinary action were warranted.

So, if you obtain a license in Colorado and practice therapeutic breast massage here, I suggest you take steps to protect yourself against such a situation. You may find legal advice helpful if you have questions about how to do that, as I cannot provide that advice.

I attached a signed copy of HB 16-1320, as it has not yet been published, where you can read the new (q) violation.

Best of luck,
Zen



Here are the rules referred to in the above email:
Source: Colorado Massage Practice Act, title 12 article 35.5
12-35.5-111. Grounds for discipline--definitions
(1) The director is authorized to take disciplinary action pursuant to section 12-35.5-112 against any person who has:
….
(b) Engaged in a sexual act with a client while a therapeutic relationship exists. For the purposes of this paragraph (b):
(I) sexual act means sexual contact, sexual intrusion, or sexual penetration as defined in section 18-3-401, C.R.S.
(II) Therapeutic relationship means the period of time commencing with the initial session of massage and ending upon written termination of the relationship from either party.
….
(o) Committed an act that does not meet, or failed to perform an act necessary to meet, generally accepted standards of massage therapy care.

....

( q) exposed an intimate part of his or her body to the view of a client or any person present with the client, or performed an act of masturbation in the presence of a client.  for the purposes of this paragraph (q) 
(!) "intimate part" means the external genitalia, the perineum, the anus, the buttocks, the pubes, or the breasts of any person.
(II) "masturbation" means the real or simulated touching, rubbing, or otherwise stimulating of a person's own genitals or pubic area, regardless of whether the genitals or pubic area is exposed or covered.
(III) "therapeutic relationship" means the period of time beginning with the initial massage therapy session and ending upon written termination of the relationship by either party.

 18-3-401. Definitions.  From: http://www.childabuseunit.com/information/pdf2/Colorado.pdf
 (4) "Sexual contact" means the knowing touching of the victim's intimate parts by the actor, or of the actor's intimate parts by the victim, or the knowing touching of the clothing covering the immediate area of the victim's or actor's intimate parts if that sexual contact is for the purposes of sexual arousal, gratification, or abuse.
(5) "Sexual intrusion" means any intrusion, however slight, by any object or any part of a person's body, except the mouth, tongue, or penis, into the genital or anal opening of another person's body if that sexual intrusion can reasonably be construed as being for the purposes of sexual arousal, gratification, or abuse.
(6) "Sexual penetration" means sexual intercourse, cunnilingus, fellatio, analingus, or anal intercourse. Emission need not be proved as an element of any sexual penetration. Any penetration, however slight, is sufficient to complete the crime.

information updated: 8/18/16

CONNECTICUT
no specific breast massage regulations*

sources of information:
http://www.ct.gov/dph/cwp/view.asp?a=3121&q=389348   
Practice act: http://www.ct.gov/dph/LIB/dph/practitioner_licensing_and_investigations/plis/massagetherapist/MSG_Statute.pdf    

text from the law/rules:
breast massage, draping:
- no mention of breasts, drapes (or sex) in these documents.  I wonder if I missed something as most/all rules include prohibitions against sex, and breast massage rules are sometimes included there.

communication with the Connecticut Board of Massage Therapists
2016/07/20 – I emailed them to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules.  email sent to  dph.alliedhealth@ct.gov.  

I received this reply: they sent me a copy of the practice act noted above, with no personal note.

information updated: 7/20/16

DELAWARE
breasts must always be draped.
no other specific breast massage regulations*

sources of information:
Tiered licensing for: Licensed massage and bodywork therapists (can do treatment work) and certified massage technicians (cannot do treatment)
Overview: http://dpr.delaware.gov/boards/massagebodyworks/index.shtml
rules and regulations: http://regulations.delaware.gov/AdminCode/title24/5300.shtml

text from the law/rules:
breast massage: no specific breast massage rules
Draping:
Use safe and functional coverage/draping practices during the practice of massage when the client is disrobed. Safe and functional coverage/draping means that the client’s genitals and gluteal cleft and the breast area of female clients are not exposed and that massage or movement of the body does not expose genitals, gluteal cleft or breast area.

communication with the Delaware Division of Professional Regulation
2016/07/22 – I emailed them to ask if they have rules about breast massage, and whether they allow breasts to be undraped to give therapeutic breast massage, or if they are in the process of writing such rules.  email sent to:  customerservice.dpr@state.de.us

2016/08/26 - I received this reply:

Thank you for your inquiry. My name is Melanie. I took your email to the Board for review and guidence, there is only one reference to breasts in our regulations, and it pertains to draping. It si regulation 11.9.

11.1.9 Use safe and functional coverage/draping practices during the practice of massage when the client is disrobed. Safe and functional coverage/draping means that the client’s genitals and gluteal cleft and the breast area of female clients are not exposed and that massage or movement of the body does not expose genitals, gluteal cleft or breast area.

Other than that there is no regulation regarding the massage of breasts at this time.



information updated: 2016/08/26

FLORIDA
no specific breast massage regulations*

sources of information:
http://floridasmassagetherapy.gov/
Entry into statutes and administrative codes: http://floridasmassagetherapy.gov/resources/

text from the law/rules:
breast massage and draping:
Chapter 456: health professions and occupations: general provisions: no mention of breast massage or draping
Chapter 480: massage practice act: no mention of breast massage or draping
Chapter 120: administrative procedures act: no mention of breast massage or draping

communication with the Florida Massage Therapy Dept
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules   
http://floridasmassagetherapy.gov/contact/.  

I received this reply:
"Ms. Heard,
I have gathered together all of the Statutes and Rules that reference draping.
Florida Administrative Code 64B7-26.003 Massage Establishment Operations.
64B7-26.003(3)(e)
(3) Safety and sanitary requirements. Each establishment shall:
(e) Maintain a sufficient supply of clean drapes for the purpose of draping each client. While the client is being massaged, and launder before reuse all materials furnished for the personal use of the client, such as drapes, towels and linens. As used herein "drapes" means towels, gowns, or sheets.

Florida Administrative Code 64B7-30.001 Misconduct and Negligence in the Practice of Massage Therapy.
64B7-30.001(4)-64B7-30.001(5)
(4) Failure to explain expected draping techniques to a client. As used in this rule, draping means towels, gowns, sheets or clothing.
(5) Failure to appropriately drape a client. Appropriate draping of a client shall include draping of the buttocks and genitalia of all clients, and breasts of female clients, unless the client gives specific informed consent to be undraped.

I could find no reference in the statutes to breast massage. However, there is a rather large section of Chapter 480 of the Florida Statutes that deals with sexual misconduct during massage. If you are going to offer this massage type to your clients I would recommend that you get explicit and fully informed consent beforehand to stop any accusations that may be levied against you. I must also say that I am not an Attorney, and while I have made a pretty thorough search through the Statutes and the Administrative Code, this email in no way represents a legal opinion.

If you have any further questions, please don’t hesitate to contact us.
Sincerely,
Joshua Huff
Regulatory Specialist II
Department of Health | Division of Medical Quality Assurance
Bureau of Health Care Practitioner Regulation | Board of Massage Therapy
4052 Bald Cypress Way, BIN C-06
Tallahassee, FL 32399-3258
(850) 245-4444, ext. 3443
Joshua.Huff@flhealth.gov
www.floridasmassagetherapy.gov

information updated: 7/29/16

GEORGIA
no specific breast massage regulations*

sources of information:
http://sos.ga.gov/index.php/licensing/plb/33
Georgia Massage Therapy Act: http://sos.ga.gov/plb/acrobat/Laws/50_Massage_Therapists_43-24APracticeAct.pdf : no mention of breasts or draping
Professions and businesses, general provisions.  http://sos.ga.gov/plb/GeneralProvisions.htm no mention of breasts or draping
Rules and regulations: http://rules.sos.state.ga.us/gac/345
http://rules.sos.ga.gov/gac/345-6 professional and unprofessional conduct

text from the law/rules:
breast massage:
no regulation
Draping:
Provide draping and treatment consistent with client safety, comfort, and privacy in compliance with recognized professional standards of massage therapy practice.

communication with the Georgia Board of Massage
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage now, or if they are in the process of writing such rules      http://sos.ga.gov/cgi-bin/EmailHealthcare2ED.asp

I received this reply: "Ms. Heard,
The Georgia Board of Massage Therapy does not have any laws or rules which specifically address breast massage nor does it currently have any legislation or regulations proposed to address any specific area of the body as it relates to massage.  

Sincerely,
*****************************
Adrienne D. Price
Executive Director - Healthcare 2
Office of Secretary of State
Professional Licensing Boards Division
237 Coliseum Drive
Macon, Georgia 31217
Ofc:  (478) 207-1693
Fax:  1(866) 888-1308
aprice@sos.ga.gov"

HAWAI'I
no specific breast massage regulations*

sources of information:
http://cca.hawaii.gov/pvl/boards/massage/
Statutes and rules: http://cca.hawaii.gov/pvl/boards/massage/statute_rules/
Administrative rules for massage: http://cca.hawaii.gov/pvl/files/2013/08/har_84-c2.pdf
Professional and vocational law: http://cca.hawaii.gov/pvl/files/2013/08/hrs_pvl_436b.pdf
Chapter 452 Massage Therapy: http://cca.hawaii.gov/pvl/files/2013/04/hrs_pvl_452.pdf

text from the law/rules:
breast massage:
no mention in any of the above pages
Draping:
no mention in any of the above pages

communication with the Hawaii Board of Massage
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage now, or if they are in the process of writing such rules    
massage@dcca.hawaii.gov   

On 8/16/16I received this reply:

Ms. Heard:
This is in response to your July 20, 2016 e-mail and inquiry regarding breast massage and draping.

At its August 10, 2016 meeting, the Board of Massage Therapy (“Board”) discussed your e-mail.

Based solely on the information provided in your e-mail, the Board voted unanimously to inform you that the Hawaii laws and rules governing massage therapy do not specifically address breast massage and/or draping.  In general, a person needs to be licensed if that person performs any activity that falls within the definition of “massage therapy” under HRS section 452-1.

For your information, the Board is currently in the process of revising its rules.  Please feel free to submit any recommendations or suggestions regarding these issues for their consideration.

Thank you for your inquiry.
Carol Kramer
 Executive Officer
 Massage Therapy Board
 P.O. Box 3469
 Honolulu, Hawaii  96801
 Phone:  (808) 586-2692
 FAX:  (808) 586-2874
http://cca.hawaii.gov/pvl/boards/massage/



information updated: 8/18/16

IDAHO
no specific breast massage regulations*

sources of information:
https://ibol.idaho.gov/IBOL/BoardPage.aspx?Bureau=MAS
State licensure law: https://legislature.idaho.gov/idstat/Title54/T54CH40.htm
State licensure rules: https://adminrules.idaho.gov/rules/current/24/2701.pdf

text from the law/rules:
breast massage:
no rules
Draping:
the code of ethics within the state licensure rules states, “Provide draping and treatment in a way that ensures the safety, comfort, and privacy of the client.”

communication with the Idaho Board of Massage
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage now, or if they are in the process of writing such rules  ibol@ibol.idaho.gov

I received this reply: "Hi.  You have contacted the Idaho massage therapy licensure board.  They do not have any laws or rules in regard to breast massage.  It was part of discussion a few times in previous meetings, but it has not been discussed in a while.
Thanks,
Erin Anderson
Technical Records Specialist I
700 State Street, PO Box 83720
Boise ID  83720
Phone 208-334-3233 ext 2592"

information updated: 7/20/16

Illinois
no specific breast massage regulations*

sources of information:
massage licensing act: http://www.idfpr.com/profs/massagetherapy.asp
Massage therapist rules: http://www.ilga.gov/commission/jcar/admincode/068/06801284sections.html

text from the law/rules:
breast massage:
not mentioned
Draping:
not mentioned

communication with the Pointillist Department of Financial and Professional Regulation
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules   http://www.idfpr.com/profs/Email/prfGrp01.asp

I received this reply: "At this time our ACT/Rules doesn't spell it out.  However, if someone is practicing beyond their scope of practice it would fall under the below in the ACT.
"Massage" or "massage  therapy" means a system of structured palpation or movement of the soft tissue of the body. The system may include, but is not limited to, techniques such as effleurage or stroking and gliding, petrissage or kneading, tapotement or percussion, friction, vibration, compression, and stretching activities as they pertain to massage therapy. These techniques may be applied by a licensed massage therapist with or without the aid of lubricants, salt or herbal preparations, hydromassage, thermal massage, or a massage device that mimics or enhances the actions possible by human hands. The purpose of the practice of massage, as licensed under this Act, is to enhance the general health and well-being of the mind and body of the recipient.
"Massage" does not include the diagnosis of a specific pathology. "Massage" does not include those acts of physical therapy or therapeutic  or corrective measures that are outside the scope of massage therapy practice as defined in this Section

(8) practicing or offering to practice beyond the scope  permitted by law or accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform

Diane Green
Board Liaison
Illinois Department of Financial and Professional Regulation
320 W Washington Street, 3rd Floor - PSS UNIT
Springfield, IL 62786
Phone: 217-524-1981
Email: diane.green@illinois.gov
Website:www.idfpr.com
"

information updated: 7/20/16

INDIANA
 breast massage allowed with written consent and education

sources of information:
http://www.in.gov/pla/massage.htm
License laws and rules:  http://www.in.gov/pla/3317.htm

text from the law/rules:
Breast massage:
Massage therapist certification Article 1 states:
(c) The certificate holder shall not do the following:
(1) Massage the breasts of a female client unless the certificate holder has:
(A) training in techniques related to therapeutic massage of mammary tissue; and
(B) first obtained informed written consent for the treatment from the client.

Draping:
Massage therapist certification Article 1 states:
Sec. 5. (a) When providing massage therapy a certificate holder shall do the following:
(1) Wear clothing that is clean, modest, and professional.
(2) Provide privacy for the client while the client is dressing and undressing.
(3) Provide draping in a manner that ensures the safety, comfort, and privacy of the client.
(4) Use draping so that the:
(A) gluteal cleft and genital areas of male and female clients; and
(B) breasts of female clients;
are not exposed.
(b) Draping is not required when the client remains fully clothed during the massage therapy session.
(c) With prior voluntary and informed consent of the client, the gluteal cleft and breast draping may be temporarily moved in order to perform therapeutic treatment to structures in those areas.

information updated: 7/20/16

IOWA
no specific breast massage regulations*
(I need to call them to clarify)

sources of information:
http://idph.iowa.gov/licensure/iowa-board-of-massage-therapy
Laws and rules: http://idph.iowa.gov/Licensure/Iowa-Board-of-Massage-Therapy/Laws-and-Rules

text from the law/rules:
Breast massage:
no rules listed
Draping:
no rules listed

communication with the Iowa Regulators:
no email address listed on website. I need to call them at
(515) 281-0254,  Iowa is 2 hours ahead of Seattle

information updated: 7/20/16

KANSAS
Kansas does not license Massage therapists

Kansas does not license massage therapists at the state level.  There may be regulations in individual towns, cities or counties.

information updated: 7/20/16

KENTUCKY
 breast massage allowed with written consent and education

sources of information:
http://bmt.ky.gov/Pages/default.aspx
laws and regulations: http://bmt.ky.gov/Laws%20and%20Regulations/Laws%20and%20Regulations%20Booklet.pdf

text from the law/rules:
Breast massage:
(2) Breast massage. A licensee performing massage of the tissue of the breast shall:
(a) Obtain the client’s informed written consent prior to providing the service;
(b) Maintain proof documenting specialized training in breast massage which addresses breast anatomy, breast pathology, and breast massage technique and which was provided by an approved massage therapy program or board approved continuing education provider;
(c) Inform the client prior to the commencement of the service that this service may be performed through a draping sheet if the client so desires and the licensee shall provide the service through a draping sheet if the client so prefers;
(d) Inform the client prior to the commencement of the service that the client may discontinue the service at any time and the licensee shall honor that election by discontinuing the provision of the service if that request is made;
(e) Keep detailed Subjective Objective Analysis Plan notes for the service such as notes related to all emotional factors that the client reports to the licensee which might impact the client’s suitability for the service and the precautions that the licensee has taken to ensure that the service is provided in a manner accounting for those emotional factors; and
(f) Refrain from an act or statement which the client may construe as being sexual in nature.

Draping:
In order to reach these objectives, the massage therapist shall:
(a) …
(e) Provide draping and treatment in a way that ensures the safety, comfort, and privacy of the client

information updated: 7/20/16

LOUISIANA
breasts must always be draped.
no specific breast massage regulations*

sources of information:
https://www.labmt.org/site.php
Practice act: https://www.labmt.org/uploads/Practice_Act_01_16_2013.pdf
rules: https://www.labmt.org/uploads/Title46ProfessionalandOccupationalStandardsPartXLIV.MassageTherapistsJuly2013.pdf

text from the law/rules:
breast massage:
no mention
Draping:  (from the massage practice act)
B.Draping. Each massage establishment shall maintain a sufficient supply of clean towels, gowns or sheets, for the purpose of covering each client during a massage. Before beginning a massage, each massage therapist shall explain to the client expected draping techniques and provide the client a clean drape for that purpose. At all times during a massage session, reasonable efforts must be made to keep covered the gluteal cleft and genitalia for male clients and the breasts, the gluteal cleft, and genitalia for female clients. The board may establish a protocol for any variation from the above described draping procedures.

communication with the Louisiana Board of Massage
2016/07/20 – I emailed them to ask if they have established variation to the draping rules to allow therapeutic breast massage, or whether they have any other rules related to breast massage.   -    admin@labmt.org
2016/07/27: I received this reply:
"Barbara,
The portion of law you cite is the correct, relevant law on this issue. The board has not established variations and there are no plans to draft additional rules at this time.
Thank you,
Shanna"

information updated: 7/20/16

MAINE
no specific breast massage regulations*
(waiting for response to email to clarify)

sources of information:
http://www.maine.gov/pfr/professionallicensing/professions/massage/
Laws and rules: http://www.maine.gov/pfr/professionallicensing/professions/massage/laws.html
http://www.maine.gov/sos/cec/rules/02/chaps02.htm#041  - chapter 400

text from the law/rules:
breast massage:
no mention
Draping:
grounds for discipline include:
•    Massage of genital areas or massage of a client who is not properly draped for massage, or by a massage therapist or massage practitioner who is not properly dressed;
•    Failure to provide draping and treatment in a way that ensures the safety, comfort and privacy of the client;

communication with the Maine Massage Therapy Licensure Program
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage now, or if they are in the process of writing such rules  

I haven't yet received a reply.

information updated: 7/20/16

MARYLAND
no specific breast massage regulations*
a new board of massage therapy which  may write new rules will be installed October 2016.

sources of information:
note: currently chiro and massage are governed by a single board.  They are separating into two individual boards.  The massage board will be established in Oct 2016.
Maryland has a two tier system:  licensed massage therapists or registered massage practitioners
http://dhmh.maryland.gov/massage/Pages/home.aspx
Laws: http://dhmh.maryland.gov/chiropractic/Pages/chiroact.aspx

text from the law/rules:
breast massage:
no mention
Draping:
no mention

communication with the Maryland Board of Chiropractic and Massage Therapy
2016/07/20 – I emailed them to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules  laurie.sheffield-james@maryland.gov

I received this reply: "All laws and regulations will be reviewed, possibly revised and possibly new laws adopted after the commencement of the new Massage Therapy Board in October 2016. Please periodically check our website.

Regards,
Adrienne Congo, MS, Deputy Director
DHMH MD Boards and Commissions,
MD BD of Chiropractic & Massage Therapy Examiners
4201 Patterson Avenue, Suite 301
Baltimore, MD 21215-2299
(410) 764-2965
Email: Adrienne.Congo@maryland.gov"

information updated: 7/20/16

MASSACHUSETTS
no specific breast massage regulations*

sources of information:
http://www.mass.gov/ocabr/licensee/dpl-boards/mt/
Statutes and regulations: http://www.mass.gov/ocabr/licensee/dpl-boards/mt/regulations/
Rules and regulations: http://www.mass.gov/ocabr/licensee/dpl-boards/mt/regulations/269-cmr/

text from the law/rules:
breast massage:
no mention
Draping:
no mention

communication with the Massachusetts Board of Massage Therapy
2 2016/07/20 – I emailed them to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules  MassageTherapy@State.MA.US
I received this reply: "Response: Hi Barbara,
If you cannot find the laws, rules in our website which you want to see, it means the board does not have the requirement for it.
Thanks,
FeiYan Chen
Board Administrator
"

information updated: 7/20/16

MICHIGAN
no specific breast massage regulations*

sources of information:
http://www.michigan.gov/lara/
Michigan Department of licensing and regulatory affairs (LARA), professional licensing section, health professional licensing, massage therapy.  - I have been unable to correctly copy the web address for this page.
public health code: http://www.legislature.mi.gov/(S(j5fglr5xqzyrrad52ru5rd2k))/mileg.aspx?page=getObject&objectName=mcl-368-1978-15-179A.
I haven't found a set of rules for Michigan massage therapy

text from the law/rules:
breast massage:
no mention
Draping:
no mention

Scope of practice: (d) "Practice of massage therapy" means the application of a system of structured touch, pressure, movement, and holding to the soft tissue of the human body in which the primary intent is to enhance or restore the health and well-being of the client. Practice of massage therapy includes complementary methods, including the external application of water, heat, cold, lubrication, salt scrubs, body wraps, or other topical preparations; and electromechanical devices that mimic or enhance the actions possible by the hands. Practice of massage therapy does not include medical diagnosis; practice of physical therapy; high-velocity, low-amplitude thrust to a joint; electrical stimulation; application of ultrasound; or prescription of medicines.

R 338.723   Prohibited conduct.    Rule 23.  Prohibited conduct includes, but is not limited to, the following acts or omissions by an individual covered by these rules:  
(a)  Practicing outside of the boundaries of professional competence, based on education, training, and experience. This includes, but is not limited to, providing massage therapy services without ensuring the safety, comfort, and privacy of the client.
(g)  Being involved in a dual or multiple relationship with a current or former client, when there is a risk of harm to, or exploitation of, the client. As used in this rule, “dual or multiple relationship” means a relationship in which a licensee is in a professional role with a client and 1 or more of the following occurs at the same time:
 
communication with the  Michigan Board of Professional Licensing
2016/07/20 – I emailed them to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules.  I also asked them if they have a set of rules governing massage therapy.  BPL-BoardSupport@michigan.gov

I received this reply:

Ms. Heard,
The State of Michigan does not prohibit breast massage, specifically.  Nor does it require draping by law.
The scope of practice for massage therapists is defined at  MCL 333.17951(1)(d).  Prohibited conduct by licensees is outlined in R 338.723 of the  Massage Therapy Rules.  Subrules (a) and (g) appear to be most applicable to your question.  The State also has  MCL 333.16221(e)(vi), which allows the Board of Massage Disciplinary Committee to sanction a licensee for “any conduct by a health professional with a patient while he or she is acting within the health profession for which he or she is licensed or registered . . . that is sexual or may reasonably be interpreted as sexual, including . . . touching of a body part for any purpose other than appropriate examination, treatment, or comfort.”
Regards,
Michael Siracuse (P75512)
Senior Policy Analyst
Boards and Committees Section
Legal Affairs Division
Bureau of Professional Licensing
Department of Licensing and Regulatory Affairs
611 W. Ottawa St., 3rd Floor
Lansing, MI 48909
siracusem@michigan.gov

information updated: 7/20/16

MINNESOTA
Minnesota does not license Massage therapists

Minnesota does not license massage therapists at the state level.  There may be regulations in individual towns, cities or counties.

information updated: 7/20/16

MISSISSIPPI
Breast Massage allowed with written consent

sources of information:
https://www.msbmt.state.ms.us/msbmt/web.nsf
Rules and regulations, effective Dec 1, 2014 
https://www.msbmt.state.ms.us/msbmt/web.nsf/webpageedit/Exams_Page_Exams_Rules/$FILE/MSBMT%20Rules%20Regulations%20Final%2012.1.2014.pdf?OpenElement

text from the law/rules:
breast massage and draping:
massage therapists must…..
10. Provide and use draping to cover all genitalia;
14. The massage therapist shall provide and use draping to cover female breast unless prior written consent is given for breast massage

Frequently asked questions
https://www.msbmt.state.ms.us/msbmt/web.nsf/webpages/LN_FAQs_Page_FAQ?OpenDocument
Is breast massage legal in Mississippi?  
Breast massage is not illegal in Mississippi, however due to the sensitivity of the procedure, it carries rules and responsibilities.  See Rules and Regulations, Section 705.A. which states ‘perform only those services for which they are qualified and which represent their training and education.’  Also refer to MSBMT Code of Ethics which state that a LMT must ‘represent their qualifications honestly, including education and professional affiliations, and provide only those services, which they are qualified to perform’; ‘provide draping and treatment in a way that ensures the safety, comfort and privacy of the client.  Provide and use draping to cover all genitalia and female breast unless prior written consent is given for breast massage’ and ‘Respect the client’s right to refuse, modify, or terminate therapy regardless of prior consent given’.

information updated: 7/20/16

MISSOURI
Breast massage allowed with physician referral or by documented clinical indication,  advanced training required

sources of information:
http://pr.mo.gov/massage.asp
rules and regulations: http://www.sos.mo.gov/adrules/csr/current/20csr/20csr.asp#20-2197  (division 2197, 2/3 down page)
standards of practice: http://s1.sos.mo.gov/cmsimages/adrules/csr/current/20csr/20c2197-3.pdf

text from the law/rules:
breast massage:
a licensee ……Shall not massage the breast unless ordered by a physician prescription or by documented clinical indication. Such documentation shall be included in the client’s record and the massage shall be performed by a licensee that is certified or has advanced training in techniques related to therapeutic treatment of mammary tissue;
Draping:
a licensee shall…. Provide appropriate draping during treatment which includes draping at the gluteal cleft and genitals on males and females and the breasts on females;

information updated: 7/20/16

MONTANA
no specific breast massage regulations*
(waiting for response to email to clarify)

sources of information:
http://b.bsd.dli.mt.gov/license/bsd_boards/lmt_board/board_page.asp
Statutes:  http://b.bsd.dli.mt.gov/license/bsd_boards/lmt_board/board_page.asp
Rules: http://b.bsd.dli.mt.gov/license/bsd_boards/lmt_board/board_page.asp

text from the law/rules:
breast massage:
no rules found
Draping:
no rules found

communication with the Montana Board of Massage Therapy
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage or draping now, or if they are in the process of writing such rules.  I also asked them if they have a set of rules governing massage therapy.    http://b.bsd.dli.mt.gov/license/bsd_boards/lmt_board/email_form.asp


I haven't yet received a reply.

information updated: 7/20/16

NEBRASKA
no specific breast massage regulations*
(waiting for response to email to clarify)

sources of information:
http://dhhs.ne.gov/publichealth/Pages/crl_mhcs_mass_massestab.aspx
Rules and regulations: http://dhhs.ne.gov/publichealth/Pages/crl_mhcs_mass_massestab.aspx#Rules
Statutes: http://dhhs.ne.gov/publichealth/Documents/Massage%20Therapy.pdf
Rules: title 172, chapter 81

text from the law/rules:
breast massage:
no mention
Draping:
81-008.02F Draping: A massage therapist must maintain appropriate draping for each client to ensure the comfort level of both the therapist and client.

communication with the Nebraska Board of Massage Therapy
2016/07/20 – I emailed them to ask if they have rules about breast massage  now, or if they are in the process of writing such rules.   rita.watson@nebraska.gov

I have not yet received a reply.

information updated: 7/20/16

NEVADA
Breast Massage allowed with written consent
no touch to nipples/areola allowed

sources of information:
http://dhhs.ne.gov/publichealth/Pages/crl_mhcs_mass_massestab.aspx
Rules and regulations:
http://massagetherapy.nv.gov/
Rules and regulations: http://massagetherapy.nv.gov/About/Regulations/
Statute: http://www.leg.state.nv.us/NRS/NRS-640C.html

text from the law/rules:
breast massage & draping:
 NRS 640C.700  Grounds for refusal to issue license or for disciplinary action.  The Board may refuse to issue a license to an applicant, or may initiate disciplinary action against a holder of a license, if the applicant or holder of the license:
      1.  ….
      (c) Massaged, touched or applied any instrument to the breasts of the person, unless the person has signed a written consent form provided by the Board;

Code (rules) http://www.leg.state.nv.us/nac/NAC-640C.html
NAC 640C.400  “Sexual activity” interpreted. (NRS 640C.320)  As used in subsection 4 of NRS 640C.700, the Board interprets the phrase “sexual activity” to include, without limitation:
     1.  …..
     7.  Not providing a client a gown or draping except as may be necessary in a medical emergency;
     8.  Removing the client’s clothing or gown or draping without consent, except as may be necessary in a medical emergency or in a custodial setting;

Breast massage consent form: http://massagetherapy.nv.gov/uploadedFiles/lmtnvgov/content/Licensees/Informed%20Consent%20Breast%20Massage.pdf: specifies that no touch of nipples or areola allowed

information updated: 7/20/16

New Hampshire
Breast Massage allowed with Informed consent, therapeutic intent, not sexual

sources of information:
http://www.dhhs.nh.gov/oos/blc/massage/
Laws and rules:  http://www.dhhs.nh.gov/oos/blc/massage/massage-law-rule.htm
Laws: http://www.gencourt.state.nh.us/rsa/html/XXX/328-B/328-B-mrg.htm
Rules: http://www.gencourt.state.nh.us/rules/state_agencies/he-p900.html

text from the law/rules:
Rules:
(l)  “Inappropriate sexual contact” means the intentional touching by the massage therapist of the client’s breasts or genitalia when such touching:
(1)  Is a therapeutic aspect of the massage, but is done without the informed consent of the client; or
(2)  Is not a necessary, therapeutic aspect of the massage; and
(3)  Is performed primarily for the purpose of sexual arousal or gratification of the massage therapist or the client.

communication with the NH department of health and human services via their website
10/15/15 I received this message from NH-DHHS-WebMail@dhhs.state.nh.us
Thank you for asking about the NH Massage Therapy Rules on Draping.  I am sending you the MT Rules of Part He-P 901.01 Definitions.  Below is also a reply from the Advisory Board Chair of Massage Therapy.

We do not have any regulations in regards to draping or how to massage the chest area. The only direction is in the rules under definitions; section L. There are 3 lines, need informed consent, therapeutically needed, not for sexual gratification. As long as they follow those 3 guidelines they are following NH's rules and regs.

Connie Beliveau
NH Massage Therapy License Clerk
(603) 271-9254

information updated: 7/20/16

NEW JERSEY
no specific breast massage regulations

sources of information:
http://www.njconsumeraffairs.gov/mbt/Pages/default.aspx
Laws and regulations: http://www.njconsumeraffairs.gov/mbt/Pages/regulations.aspx
Statutes: http://www.njconsumeraffairs.gov/Statutes/massagelaw.pdf
Administrative code (rules) http://www.njconsumeraffairs.gov/regulations/Chapter-37A-New-Jersey-Board-of-Massage-and-Bodywork-Therapy.pdf (this includes scope of practice)

text from the law/rules:  (there is no specific mention of breast massage in their rules)

scope of practice
13:37A-3.1 SCOPE OF PRACTICE
a) A licensee shall practice only those methods of massage and bodywork therapy that:
1) The licensee learned during his or her initial training as outlined in N.J.A.C. 13:37A-2.1 or 2.5;
2) The licensee learned during a course offered by:
i. A provider approved by the NCBTMB, NCCAOM, American Massage Therapy Association (AMTA), Associated Bodywork and Massage Professionals (ABMP), FSMTB, American Nurse Credentialing Center (ANCC), American Organization for Bodywork Therapies of Asia (AOBTA), American Polarity Therapy Association (APTA), American Physical Therapy Association (APTA), American Medical Association (AMA), International Association of Structural Integrators (IASI), Ida P. Rolf Research Foundation, a state board of massage, a state board of massage and bodywork, a state board of physical therapy or a state board of chiropractic;
ii. A school which is approved by an agency recognized by the United States Department of Education; or
iii. A school which is accredited or approved by the New Jersey Department of Education, the New Jersey Department of Labor and Workforce Development, the New Jersey Commission on Higher Education, or an agency of another state with requirements substantially similar to the requirements of the New Jersey Department of Education, the New Jersey Department of Labor and Workforce Development or the New Jersey Commission on Higher Education; or
3) The licensee developed and which are taught, or have been taught, in a course offered by a provider approved by the NCBTMB, NCCAOM, American Massage Therapy Association (AMTA), Associated Bodywork and Massage Professionals (ABMP), FSMTB, American Nurse Credentialing Center (ANCC), American Organization for Bodywork Therapies of Asia (AOBTA), American Polarity Therapy Association (APTA), American Physical
Therapy Association (APTA), American Medical Association (AMA), International Association of Structural Integrators (IASI), Ida P. Rolf Research Foundation, a state board of massage, a state board of massage and bodywork, a state board of physical therapy or a state board of chiropractic.

b) Notwithstanding any training received as permitted by (a) above, a licensee shall not perform:
1) Vaginal or penile massages;
2) Animal therapies prohibited by the Veterinary Medical Act, N.J.S.A. 45:16-1, et seq.;
3) Any application of electrical current to the body (Transcutaneous Electronic Nerve
Stimulation, TENS, machine); and
4) Diagnosis of illness, disease, impairment or disability.


draping and breast massage
Draping/Infection control: Clean linens and drapes or disposable coverings shall be used for each client.
Sexual misconduct includes: A licensee shall provide privacy and therapy conditions which prevent the exposure of the unclothed body of the client. Appropriate draping measures shall be employed to protect client privacy.

communication with the NJ consumer affairs department
2016/07/20 – I emailed them via their website to ask if they have rules about breast massage now, or if they are in the process of writing such rules.  askconsumeraffairs@dca.lps.state.nj.us.  They replied on 2016/12/14 and referred me to the scope of practice rules which I've included above.  link:  http://www.njconsumeraffairs.gov/regulations/Chapter-37A-New-Jersey-Board-of-Massage-and-Bodywork-Therapy.pdf

information updated: 12/14/16

NEW MEXICO
no specific breast massage regulations*
(waiting for response to email to clarify)

sources of information:
http://www.rld.state.nm.us/boards/massage_therapy.aspx
Rules and laws: http://www.rld.state.nm.us/boards/Massage_Therapy_Rules_and_Laws.aspx
Administrative code: http://164.64.110.239/nmac/_title16/T16C007.htm

text from the law/rules:
breast massage:
no rules
draping and general massage, in the code of conduct:
(2) obtain prior informed consent of the client regarding draping and treatment to ensure the safety, comfort and privacy of the client;

communication with the NM Board of Massage
2016/07/20 – I emailed them to ask if they have rules about breast massage now, or if they are in the process of writing such rules.  massage.board@state.nm.us

I have not yet received a reply.

information updated: 7/20/16

New York
breast massage allowed with informed consent

sources of information:
http://www.op.nysed.gov/prof/mt/mtlic.htm
rules and laws: http://www.op.nysed.gov/prof/mt/mtlaw.htm
http://www.op.nysed.gov/title8/part29.htm
http://www.op.nysed.gov/prof/mt/mtguide.htm

text from the law/rules:
breast massage:
When massage of breast tissue is therapeutically indicated, the female patient/client must be fully informed and give consent before the therapist undrapes the breast for treatment.
draping:
the provisions of Section 29.1(b)(5) of this Part prohibiting immoral conduct shall apply in the practice of massage therapy. Massage of genital areas and massage of a client who is not properly draped for massage, or by a massage therapist who is not properly dressed, shall be considered immoral conduct;
•    Massage of genital areas and massage of a patient/client who is not properly draped for massage shall be considered immoral conduct.
•    The practice of massage by a massage therapist who is not properly dressed shall be considered immoral conduct.
•    Draping includes methods used by a massage therapist to protect modesty, privacy, warmth and/or comfort of a patient/client by the use of sheets, towels, blankets or any item that serves this purpose.
 
information updated: 7/20/16

NORTH CAROLINA
breast massage allowed with informed consent

sources of information:
https://www.bmbt.org/
Practice act and rules: https://www.bmbt.org/pages/DocumentCenter.html
Practice act: https://www.bmbt.org/downloads/Practice%20Act%20With%20Revisions%2007-08-3.pdf
Rules: https://www.bmbt.org/downloads/Rules%20and%20Regulations%20Revised%2010-2015.pdf

text from the law/rules:
breast massage and draping:
Licensees shall adhere to the following requirements, except in the case of treatments where the client remains fully clothed:
(1) provide draping in a manner that ensures the safety, comfort and privacy of the client;
(2) maintain a supply of clean drapes, such as towels, sheets, gowns or other coverings, for the purpose of draping the client's body during treatment;
(3) explain expected draping procedures to the client before treatment; and
(4) ensure that the following areas are draped during treatment: the gluteal and genital areas for male and female clients, and the breast area for female clients. With voluntary and informed consent of the client, the gluteal and breast drapes may be temporarily moved in order to perform therapeutic treatment to structures in those areas.

information updated: 7/20/16

NORTH DAKOTA
no specific breast massage regulations*

sources of information:
http://www.ndboardofmassage.com/
Laws and rules: http://www.ndboardofmassage.com/laws-and-rules-tab/
law: http://www.legis.nd.gov/cencode/t43c25.pdf?20150902110347
rules:  http://www.legis.nd.gov/information/acdata/pdf/49-03-01.pdf

text from the law/rules:
breast massage:
no rules
draping:
A therapist must provide draping and treatment in a way that ensures the personal safety, comfort, and privacy of the client.

communication with the North Dakota Board of Massage
2016/07/20 – I emailed them to ask if they have rules about breast massage now, or if they are in the process of writing such rules.  pb.lmt.nd@gmail.com

I received this reply: "Barbara, Thank you for opening discussion on an interesting topic. As of this time we have no specific law or rule on this issue but it is certainly something for us to consider in the upcoming months. When we do discuss this topic, may I use you for information and reference since it seems you are compiling data?
Again, thank you for your interest and have a wonderful day.
Pat Berg"

information updated: 7/20/16

OHIO
no specific breast massage regulations*
(I need to call them to clarify)

sources of information:
http://med.ohio.gov/Applicants/MassageTherapy(MT).aspx
Ohio laws and rules group together professions of md od dp mt cosmetic therapists, anesthesiology assistants, and board operations
Statutes: http://med.ohio.gov/LawsRules/Statutes.aspx   http://codes.ohio.gov/orc/4731
Rules: http://med.ohio.gov/LawsRules/Rules.aspx

text from the law/rules:
breast massage:
no rules
draping:
no rules

communication with the Ohio Massage Board
2016/07/20 – No email address listed on websit (614) 466 - 3934 

information updated: 7/20/16

OKLAHOMA
rules have not yet been written
(waiting for response to email to clarify)

State level licensing approved 5/2016 under the Board of cosmetology and barbering

sources of information:
https://www.ok.gov/cosmo/
the law creating the massage license:  http://webserver1.lsb.state.ok.us/cf_pdf/2015-16%20ENR/SB/SB687%20ENR.PDF

text from the law/rules:
Don’t appear to be any rules yet.  The board of cosmetology and barbering website does not mention massage.

communication with the Oklahoma Cosmetology department
I sent a message via the website asking who is writing the rules.  https://www.ok.gov/triton/contact.php?ac=191&id=167 

I have not yet received a reply.

information updated: 7/20/16

OREGON
Breast massage allowed with written consent, education, therapeutic rationale

sources of information:
http://www.oregon.gov/OBMT/Pages/index.aspx
Laws, rules policies: http://www.oregon.gov/OBMT/Pages/lawsrulespolicies.aspx
Statutes: http://www.oregon.gov/OBMT/Documents/Revised%20Statutes%202015%20EDITION%20-%20Revised%2002.11.2016.pdf
Rules:
http://www.oregon.gov/OBMT/docs/OAR%20July%202016%20Edition%20Final.pdf , dated July 1, 2016

text from the law/rules:
breast massage:
(1) Prior to performing breast massage to treat certain medical conditions, a LMT must:
(a) be able to present evidence of the completion of specialized contact hours as training beyond the minimum competencies, which includes but is not limited to, indications, contraindications, therapeutic treatment techniques, expected outcomes, client safety, client consent, client communication, draping techniques, sanitation, and ethical responsibilities related to breast massage;
(b) be able to articulate a therapeutic rationale which is acknowledged by the client; rationale may include a medical prescription and/or permission to consult with the clients health care provider(s).
(c) acquire prior written and verbal consent before proceeding; the written consent must include clients’ option to accept or decline to provide a witness, in addition to the client and LMT.
(2) While performing these procedures a LMT must use appropriate draping techniques at all times. Any temporary exposure of the breast area for the purposes of treatment is acceptable only in respect to appropriate procedures for that treatment. Immediately following treatment of the area, the breast area must be covered again.
(3) Additional prior written consent and the actual presence of a parent or legal guardian is required when treating individuals under 18 years of age.

draping:
(3) A massage therapist must use safe and functional coverage/draping practices during the practice of massage when the client is disrobed.
(a) Safe and functional coverage/draping means:
(A) LMT explains, maintains and respects coverage/draping boundaries;
(B) Client gives informed consent;
(C) Genitals and gluteal cleft of male and female clients and the breast area of female clients are not exposed;
(i) With voluntary and informed consent of the client, the gluteal and breast drapes may be temporarily moved in order to perform therapeutic treatment of the area.
(D) Massage or movement of the body does not expose genitals, gluteal cleft or breast area.
(b) Exceptions to the rule may be made for LMTs who can document training in specific modalities that require variations in coverage/draping.

information updated: 7/20/16

PENNSYLVANIA
breast massage allowed with written consent

sources of information:
hhttp://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/MassageTherapy/Pages/default.aspx
Laws and regulations: http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/MassageTherapy/Pages/Board-Laws-and-Regulations.aspx
Law (massage therapy act) http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/MassageTherapy/Documents/Applications%20and%20Forms/Non-Application%20Documents/MTM%20-%20Act%20118%20Amended%20Massage%20Therapy.pdf
Code/rules: http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/MassageTherapy/Documents/Applications%20and%20Forms/Non-Application%20Documents/MTM%20-%20Act%20118%20Amended%20Massage%20Therapy.pdf

text from the law/rules:
breast massage:
(7)  Obtain written consent prior to performing breast massage.
draping:
Standard of professional conduct includes:
(10)  Use safe and functional coverage/draping practices during the practice of massage therapy when the client is disrobed. Safe and functional coverage/draping means that the client’s genitals and gluteal cleft and the breast area of female clients are not exposed and that massage or movement of the body does not expose genitals, gluteal cleft or breast area. With voluntary and informed consent of the client, the gluteal and breast drapes may be temporarily moved in order to perform treatment of the area.

information updated: 7/20/16

RHODE ISLAND
no specific breast massage regulations*

sources of information:
http://www.health.ri.gov/licenses/detail.php?id=229
Rules: http://sos.ri.gov/documents/archives/regdocs/released/pdf/DOH/7016.pdf

text from the law/rules:
breast massage:
no rules
draping:
no rules

communication with the Rhode Island health department
2016/07/20 – I emailed them to ask if they have rules about breast massage and/or draping now, or if they are in the process of writing such rules. 
http://www.health.ri.gov/contact/

I received this reply:
"Good Morning,
Please see Chapter 23-20. 8-9 (7) of the RI Statute: Nothing in the section shall be construed to prevent or restrict the practice of any person in this state who uses touch to affect the energy systems, acupoints or Qi meridians (channels of energy) of the human body while engaged within the scope of practice of a  profession with established standards and ethics, provided that his or her service is not designated or implied to be massage or massage therapy. Such practices include, but are not limited to, Polarity, Polarity Therapy, Polarity Bodywork Therapy, Rosen Method, Asian Bodywork Therapy, Acupressure, Jin Shin Do/rs, Qi Gong, Reiki and Shiatsu. Practitioners must be recognized by or meet the established standards of either a professional organization or credentialing agency that represents or certified the respective practice based on a minimal level of training, demonstration of competency and adherence to ethical standards.
 
There is no mention of breast massage.
It is out of my jurisdiction.
At the present time the board is not in the process of writing such rules.
 
Alana Rodriguez
Board Manager
Center for Professional Boards and Commissions
RI Department of Health
(t) 401.222.1392
(fax) 401.222.2158"

information updated: 7/20/16

SOUTH CAROLINA
breast Massage allowed with prior written consent and/or physician referral - with medical issues physician referral required

sources of information:
http://www.llr.state.sc.us/pol/massagetherapy/
Laws and policies: http://www.llr.state.sc.us/pol/massagetherapy/index.asp?file=laws.htm
Massage practice act: http://www.scstatehouse.gov/code/t40c030.php
Code/rules: http://www.scstatehouse.gov/coderegs/Ch%2077.pdf
Interpretations of the massage bodyworks practice act: http://www.llr.state.sc.us/pol/massagetherapy/index.asp?file=interpretations_of_the_massage_p.htm
http://www.llr.state.sc.us/pol/massagetherapy/index.asp?file=interpretations_of_the_massage_p.htm

text from the law/rules:
Frequently Asked Questions
B. Standards of Conduct
1. Draping of Clients: Licensees shall provide a clean drape for each client for the purpose of maintaining professional standards, and to ensure the clients safety, comfort, and privacy. The areas that must be draped are the gluteal and genital areas for male and female clients, and the breast area for female clients. The drape may be adjusted in order to perform therapeutic treatment to the gluteal and breast tissue.
2. Breast Massage: For the protection of the client and the massage therapist, massage of the breasts must be performed in a professional and ethical manner and with prior written consent from the client or physician referral on file. When medical reasons are involved and contraindications may be an issue, a physician's referral is necessary.

information updated: 7/20/16

SOUTH DAKOTA
no specific breast massage regulations*
(waiting for response to email to clarify)

sources of information:
https://doh.sd.gov/boards/massage/
Statute/laws: http://sdlegislature.gov/statutes/Codified_laws/DisplayStatute.aspx?Statute=36-35&Type=Statute
Rules: http://sdlegislature.gov/Rules/DisplayRule.aspx?Rule=20:76

text from the law/rules:
breast massage
no rules
draping
no rules

communication with the South Dakota Board of Massage
2016/07/21 – I emailed them to ask if they have rules about breast massage and/or draping now, or if they are in the process of writing such rules.  SDBMT@midwestsolutionssd.com

I have not yet received a reply.

information updated: 7/21/16

TENNESSEE
breast massage allowed by same gender client-therapist only, and with written consent

sources of information:
https://www.tn.gov/health/article/ML-applications
statutes and rules: https://www.tn.gov/health/article/ML-statutes
rules: http://share.tn.gov/sos/rules/0870/0870.htm

text from the law/rules:
breast massage:
Refrain, under all circumstances, from providing the following treatments, which are prohibited and not within the scope of practice for massage therapists [... including]  Cross-gender breast massage

Respect the client’s right to treatment with informed and voluntary consent by obtaining and recording informed voluntary written consent of the client, or client’s advocate,
before performing: […]  Therapeutic same-gender breast massage.

draping
Provide draping and treatment in a way that ensures the safety, comfort and privacy of the client.
Before proceeding with a massage, explain to the client expected draping techniques and provide the client a clean drape large enough for the purpose of draping the buttocks and genitalia and, in the case of female clients, the breasts. Such body parts must remain covered except during therapeutic treatment of those specific areas, with the exception of the genitalia, which shall always remain covered;

information updated: 7/21/16

TEXAS
breast massage allowed with written consent

sources of information:
https://www.dshs.texas.gov/massage/mt_rules.shtm
https://www.dshs.state.tx.us/massage/mt_consult.shtm

text from the law/rules:
draping and general
Licensees are required to provide an initial consultation to each client prior to the first massage session and obtain the signature of the client on a consultation document. The document must include:
•    the type of massage techniques the registrant anticipates using during the massage therapy session;
•    the parts of the client's body that will be massaged or the areas of the client's body that will be avoided during the session, including indications and contraindications;
•    a statement that the licensee shall not engage in breast massage of female clients without the written consent of the client;
•    a statement that draping will be used during the session, unless otherwise agreed to by both the client and the licensee;
•    a statement that if uncomfortable for any reason, the client may ask the licensee to cease the massage and the licensee will end the massage session; and
•    the signature of both the client and the licensee.

Breast massage:
(a) A licensee shall not engage in sexual contact during a session with a client. For the purposes of this section, sexual contact includes:
    (1) any touching of any part of the genitalia or anus;
    (2) any touching of the breasts of a female client, unless the touching is breast massage that is specifically authorized by the client through the signed consultation document referenced in §140.304(a)(3) of this title (relating to Consultation Document);

(j) For purposes of this section:
(1) "Nude" means a person who is:
(A) entirely unclothed; or
(B) clothed in a manner that leaves uncovered or visible through less than fully opaque clothing any portion of the breasts below the top of the areola of the breasts or any portion of the genitals or buttocks.

(2) "Sexual contact" includes:
(A) any touching of any part of the genitalia or anus;
(B) any touching of the breasts of a female client, unless the touching is breast massage that is specifically authorized by the client through the signed consultation document referenced in §140.304(a)(3) of this title (relating to Consultation Document);

information updated: 7/21/16

UTAH
breast massage allowed with written consent

sources of information:
http://www.dopl.utah.gov/licensing/massage_therapy.html
massage therapy practice act http://le.utah.gov/xcode/Title58/Chapter47B/58-47b.html
rules:  http://www.dopl.utah.gov/laws/R156-47b.pdf

text from the law/rules:
breast massage:
from the massage therapy practice act:
Definitions: (2) "Breast" means the female mammary gland and does not include the muscles, connective tissue, or other soft tissue of the upper chest.
58-47b-501.  Unlawful conduct.
     "Unlawful conduct" includes:  ….
(3)    massaging, touching, or applying any instrument or device by a licensee in the course of practicing or engaging in massage therapy to:
(a)    genitals or anus; and
(b)    breasts of a female patron, except when a female patron requests breast massage, as may be further defined by division rule, and signs a written consent form, which must also include the signature of a parent or legal guardian if the patron is a minor, authorizing the procedure and outlining the reason for it before the procedure is performed.
(Note: the rules do not address breast massage.)
draping:
From the rules:
 (2) "Body wrap" means a body treatment that:
(a) may include one or more therapeutic preparations;
(b) is not for cosmetic purposes; and
(c) maintains modesty by draping the body fully or partially.
R156-47b-502. Unprofessional Conduct.
"Unprofessional conduct" includes: ….
(7) failure to use appropriate draping procedures to protect the client's personal privacy;

information updated: 7/21/16

VERMONT
Vermont does not license massage therapists

Vermont does not license massage therapists at the state level.  There may be regulations in individual towns, cities or counties.

information updated: 7/20/16

VIRGINIA
nipples and areola may only be touched with medical condition and referral

sources of information: (Massage is regulated by DOH department of nursing.)
http://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm
Regulations governing the certification of massage therapists can be downloaded from this website↑.
http://www.dhp.virginia.gov/nursing/nursing_guidelines.htm - massage therapist section 90-47

text from the law/rules:
draping and breast massage rules
Areas that should be draped and not touched unless medically indicated for a condition referred by a physician, nurse practitioner or physician assistant and with the written informed consent of the client include:  Anus, penis, testicles, scrotum, vagina, labia, clitoris, nipples, and areola.

communication with the Virginia DOH department of nursing.
7/19/16  I emailed nursebd@dhp.virginia.gov to ask whether they have regulations for breast massage or draping.

They replied:
Ms. Heard,
Please see the section on the left hand side of the Virginia Board of Nursing website titled: Guidance Documents.  See Guidance Document 90-47 under  Massage Therapist

Latasha Austin
Discipline Specialist & Massage Therapy Certification Specialist
Department of Health Professions
Virginia Board of Nursing
9960 Mayland Drive, Suite 300
Henrico, Virginia 23233-1463
www.dhp.virginia.gov 

information updated: 7/26/16

WASHINGTON STATE
Breast massage allowed  consistent with community standards of practice
New rules currently being drafted

sources of information:
http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MassageTherapist
Laws and rules/code:  http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MassageTherapist/Laws
Laws: http://app.leg.wa.gov/rcw/default.aspx?cite=18.108
Rules/Code: http://app.leg.wa.gov/wac/default.aspx?cite=246-830

NOTE:  The WA Board of Massage is in the process of updating all rules, and is drafting new rules for both draping and breast massage.  These are likely to go into effect sometime in 2017.

text from the law/rules:
There are no breast massage or draping rules within the within the code specific to massage therapists
The following rules for draping and breast massage are for  all health care providers  http://app.leg.wa.gov/wac/default.aspx?cite=246-16-100
WAC 246-16-100
Sexual misconduct.
(1) A health care provider shall not engage, or attempt to engage, in sexual misconduct with a current patient, client, or key party, inside or outside the health care setting. Sexual misconduct shall constitute grounds for disciplinary action. Sexual misconduct includes but is not limited to: …
(b) Touching the breasts, genitals, anus or any sexualized body part except as consistent with accepted community standards of practice for examination, diagnosis and treatment and within the health care practitioner's scope of practice;
…..
(h) Not providing the patient or client a gown or draping except as may be necessary in emergencies;

information updated: 7/26/16

WASHINGTON, DC
no specific breast massage regulations*

sources of information:
http://doh.dc.gov/service/massage-therapy-licensing
Municipal regulations for massage: http://doh.dc.gov/node/237642

text from the law/rules:
Draping:
Use appropriate draping to protect the client’s physical and emotional privacy.

Breast massage: not mentioned

information updated: 7/21/16

WEST VIRGINIA
breast massage allowed with written consent and a plan of care

sources of information:
http://www.wvmassage.org/
Rules and regulations: http://www.wvmassage.org/rules.asp
Laws: http://www.wvmassage.org/rules.asp?show=state (no mention of breasts or draping)

text from the law/rules:
Rules: http://www.wvmassage.org/rules.asp
Draping:
4.1.f.  Launder, before reuse, all materials furnished for the personal use of the massage therapy client, such as towels, linens and any draping materials;
4.1.g.  Before proceeding with the massage of a client, explain expected draping techniques and provide the client a clean drape or drapes for the purpose of covering the body in accordance with generally-accepted standards of practice;
Breast massage
4.1.h.  Obtain informed, voluntary consent in writing prior to performing breast massage.  A breast massage may only be performed as indicated in a plan of care.  Failure to comply with this subdivision constitutes grounds for revocation of license;

Information updated: 7/21/16

wISCONSIN
no specific breast massage regulations*

sources of information:
http://dsps.wi.gov/Default.aspx?Page=3ebd571e-6b70-442f-b8b0-d1b35d0d758f
Statutes and rules: http://dsps.wi.gov/Boards-Councils/Administrative-Rules-and-Statutes/Massage-Therapists-and-Bodyworkers-Administrative-Rules-and-Statutes/
Statutes: https://docs.legis.wisconsin.gov/statutes/statutes/460.pdf  - no mention of draping or breast massage.
Rules: https://docs.legis.wisconsin.gov/code/admin_code/mtbt/5.pdf

text from the law/rules:
Draping:
MTBT 5.02 Unprofessional conduct. “Unprofessional conduct” includes the following, or aiding, abetting, or conspiring the same: …
(21) Failing to provide draping and treatment that ensures the safety and privacy of a client.
Breast massage
not mentioned.

7/21/16  I emailed department of Safety and professional service to ask whether they have regulations for breast massage or draping.  (they oversee massage therapists) dsps@wisconsin.gov 

They replied:
"Good afternoon,
Credential holders are responsible for their own professional practice and for compliance with the law. The Department is unable to answer questions regarding:
·         Potential or ongoing litigation
·         Billing issues
·         Business advice
·         Employer/employee disputes
·         Legal opinions
·         Scope of practice
·         Questions involving professional judgment or discretion
The Department’s website provides a wide range of materials to assist credential holders, as well as the public, in answering questions about the practice of the various professions. These materials include the relevant Wisconsin Statutes, Wisconsin Administrative Code, formal disciplinary orders, meeting minutes, and frequently asked practice questions (Position Statements) developed for many of the professions. The address for the Department’s website is http://dsps.wi.gov.

To find the resources available on this website, please select the Board you are inquiring about from this list, then look for the Statutes and Administrative Codes and/or Position Statements:
Board Council Listing

If after reviewing the website and materials you still have questions, you may submit an item for consideration at a Board or Council meeting by using the following link and filling in the form: 
Public Board Agenda Item
Please let us know if you need further assistance.

Regards,
Ronda Statz
Office Operations Associate
Department of Safety & Professional Services
Division of Professional Credential Processing
1400 East Washington Avenue
Madison, Wisconsin  53703
(608) 266-2112
dsps@wi.gov
The DSPS is committed to service excellence.  Visit our survey at https://www.surveymonkey.com/s/DSPSCustomerServiceCenter to evaluate your experience with the DSPS.


information updated: 7/26/16

WYOMING
Wyoming does not license massage therapists

Vermont does not license massage therapists at the state level.  There may be regulations in individual towns, cities or counties.

information updated: 7/20/16

 

* No Specific Breast Massage Regulations

States which license massage therapists commonly have general regulations requiring massage therapists to:

  1. work within our level of training, and to represent our qualifications and education honestly
  2. avoid all sexual contact

Even if a state has no specific breast massage regulations, these two regulations always apply to the practice of therapeutic breast massage.

education

Because most massage schools do not include breast massage in the basic education they provide, it is prudent for massage therapists who offer breast massage to attend continuing education classes to obtain specific training in giving therapeutic breast massage.

keeping the massage therapeutic
avoiding sexual touch
obtaining written consent

Massage of the breasts can be experienced by the receiver as sexually stimulating, whether or not the massage therapist has this intent.  To minimize the likeliness of this happening, it is prudent for the massage therapist to establish with the client before the session begins that the intent of the massage offered is 100% therapeutic, and never intended as sexual. Obtaining informed, written consent from the receiver before the session can help to establish this boundaries.

This protocol is intended to minimize instances of clients receiving unwanted touch while maintaining the availability, legality and benefits of therapeutic breast massage for those who wish to give and receive this work.

  

Breast & Chest  Massage 
pages on this website