Can I massage a client with lymphoedema or after lymph node removal?

Short answer: not with a standard massage — and not on the affected limb or quadrant at all unless you hold a specific lymphoedema qualification.

This is one of the few contraindications where a well-meaning, competent therapist can genuinely make someone worse. If lymph nodes have been removed or damaged — most commonly axillary nodes after breast cancer surgery, or groin nodes after gynaecological or melanoma surgery — the drainage route on that side is gone. Normal Swedish or deep tissue work increases fluid load into a system that can't clear it. The result is swelling that can take weeks to settle, or a first-time lymphoedema episode in a limb that was previously fine. Broken or stretched skin on a lymphoedematous limb also carries a real cellulitis risk, which is a hospital problem, not a salon one.

Manual lymphatic drainage (MLD) is a separate, certified discipline — Vodder, Leduc, Casley-Smith. If you haven't trained in it, "gentle lymphatic-style strokes" is not a safe substitute.

What to do instead:

• Ask about cancer surgery, node removal and radiotherapy at consultation — not just "any medical conditions?"
• Treat the unaffected areas only. A back and shoulder massage avoiding the affected side, or a scalp and foot treatment, is usually fine.
• Avoid heat on the affected area — hot stones, saunas, steam, hot towels — all increase swelling.
• No compression from tight positioning, and never remove or work under a compression garment.
• If the limb is red, hot, unusually swollen or painful, don't treat. That's a possible infection — GP same day.
• Refer to a trained MLD therapist or the client's lymphoedema clinic rather than improvising.

Record the surgery, which side, and what you agreed to avoid.