How to Treat Nipple Blebs While Breastfeeding

Treatment of Milk Blisters

Woman breast feeding her baby
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A nipple bleb is a tiny white or yellow spot that forms on the nipple at the end of a milk duct or nipple pore. It is believed to be a small, milk-filled cyst, a milk blister, or a blockage created from breast milk that has become thick and hard. A nipple bleb tends to appear as a smooth, shiny, singular white dot that resembles a whitehead pimple, and it is often associated with a plugged milk duct.

It may not be bothersome at all, but for some women, it can cause extreme pain during breastfeeding.

Breastfeeding With a Nipple Bleb

If it isn't painful, you can just leave a milk blister alone. It may go away on its own in a few days or weeks. But, even if it is very painful, you should continue to breastfeed your baby or pump very often. The frequent removal of breast milk is important to maintain your breast milk supply. It can also help prevent clogged ducts, breast engorgement, and mastitis.

How to Treat Nipple Blebs While Breastfeeding

If you get a nipple bleb, you want to try to remain as comfortable as possible while waiting for the problem to resolve. Here's what you can do to try to relieve the pain and heal more quickly:

  1. Breastfeed very often and make sure your baby is latching on correctly.
  2. Soak, massage, and apply heat to the bleb to try to open the milk duct and loosen up the blockage.
  1. Rub your nipples with liquid lecithin, an antibiotic ointment, or Dr. Jack Newman's All-Purpose Nipple Ointment a few times a day after breastfeeding. 
  2. Use ice packs or cold cabbage leaves to ease the pain in your breasts. You can also ask your doctor if you can take a pain reliever such as Tylenol ​(acetaminophen) or Motrin (ibuprofen). 
  1. If the fabric of your bra or clothing rubs against the bleb and causes discomfort, you can wear breast shells to protect your breasts
  2. Talk to your doctor or a lactation consultant about taking a lecithin supplement. Lecithin is believed to help heal and prevent plugged milk ducts so it may be helpful for a bleb. A typical dose is one tablespoon of liquid or granulated lecithin per day, or one 1200 milligram capsule three to four times per day.
  3. Try to clean the area and remove the blockage by gently rubbing the bleb with a washcloth or scraping it with a clean fingernail.
  4. If you can tolerate it, you can use gentle pressure from behind the bleb to try to squeeze the blockage out.
  5. Try to prevent the milk ducts from becoming clogged by using proper breastfeeding technique, nursing often, alternating breastfeeding positions and avoiding tight tops and underwire bras.

When to See the Doctor

If a nipple bleb is painful and does not go away, even with a good latch and frequent breastfeeding, you should meet with your doctor. Sometimes a thin layer of skin develops over the area and covers the milk bleb preventing it from getting better. Your health professional can use a sterile needle to break open the skin and remove the nipple bleb.

You should also notify the doctor if you develop a fever, or notice redness, swelling or drainage (that isn't breast milk) at the site. These are signs of an infection.

What Else It Could Be

Nipple blebs are sometimes confused with other breast problems. Issues such as nipple blisters or thrush may look similar to a milk blister.

A nipple blister is larger than a nipple bleb and does not usually cause such excruciating pain. Blisters are often the result of a poor latch or friction caused by a powerful suck. Once breastfeeding technique is corrected, nipple blisters will usually heal on their own within a few days.

Thrush is a fungal (yeast) infection that can cause severe burning and pain, especially during breastfeeding. Thrush may cause the nipples to appear shiny and red, but it can also look like small white patches on the skin. So, if there are a few milk blebs on the nipple, it could resemble thrush. Since thrush and nipple blebs require different treatment, it's important to figure out which issue you're dealing with. Thrush can spread quickly and lead to other breast problems such as mastitis, a painful breast infection. If you think you may have thrush, notify your doctor. Both you and your baby will need an anti-fungal medication to treat thrush.

Sources

Amir LH, Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol# 4: Mastitis, revised March 2014. Breastfeeding Medicine. 2014 June 1;9(5):239-43.

Berens P, Eglash A, Malloy M, Steube AM, Academy of Breastfeeding Medicine. ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeeding Medicine. 2016 March 1;11(2):46-53.

Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, Menon LL, Scott C, Mather-McCaw G, Navarro K, Geddes DT. Nipple pain in breastfeeding mothers: incidence, causes, and treatments. International journal of environmental research and public health. 2015 September 29;12(10):12247-63.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD.  Breastfeeding A Guide For The Medical Profession Eighth Edition. Elsevier Health Sciences. 2015.

McGuire E. Case study: White spot and lecithin. Breastfeeding Review. 2015 April 23; (1):23.

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