The male therapist massaging a female client would be well advised to get that consent in writing. The therapist in this situation should be alert to the possibility the client revokes the consent, which should immediately end this segment of the massage. If the therapist has consent but the client indicates uncertainty or discomfort, the therapist ought to decline that part of the massage. The male therapist should be careful to make no comment about this part of the anatomy; even if meant well, it is bound to come out wrong and to sound unprofessional. Some therapists simply do not offer female breast massage.

Some states may require that the consent for breast massage be in writing regardless of the therapist's gender (Arizona , Texas and Utah are examples.)

There are contraindications to massaging the breast. Infection may indicate the breast should not be massaged even if the client consents. An undiagnosed lump or abscess indicates that particular area should be left alone. A therapist should only massage the breasts of a client with breast cancer only after training and only with permission from the client's doctor. Some opinion believes separate training should be secured before doing any breast massage. Breast massage may be illegal in some jurisdictions.

A sampling of U.S. therapists in 1997 found that only 9% practiced breast massage and that only 10% of schools taught it. One teacher was banned from teaching in North Carolina for offering a course on the technique. Breast massage is more common in Canada.