The Truth About Nipple Blebs

What really is the truth about nipple blebs? As I was researching this article, I found all of the out dated recommendations on how to deal with this pesky problem.

Travel with me back in time a little. Have you ever had a giant pimple on your face? All you want to do is have the sense of satisfaction that would come from popping it, but your inner self knows better than to do that. The voice inside of your head is channeling your mother’s voice from when you were a pimply teenager. “Don’t pop that zit or you are going to have a scar on your face!”

While we know this logic to be true, it is so tempting to just go for it. Nipple blebs are similar, except that we used to think that “popping” them was actually the treatment. Even as early as 6 years ago when I was starting my pediatric and lactation practice, I would see moms for nipple blebs so that I could “unroof” them with a sterile needle.

Thankfully as we know better, we do better. After pursuing breastfeeding medicine and becoming board certified in the specialty, I am beginning to realize how much lactation information just gets passed down with little thought for its scientific basis.

This article is an attempt to surround this breastfeeding problem with science. If we approach it from the angle of the actual evidence, we will see the truth about nipple blebs.

Definition of Nipple Bleb

A nipple bleb or milk blister is a little white (or yellow) dot that forms over the surface of a nipple pore or opening for a breastfeeding mother. You can have one or several of these spots on your nipple at a time. 

These blisters are more of a nuisance than anything dangerous. They are not caused by yeast and are not associated with cancer. 

However, they can cause nursing mothers a lot of pain and make nursing sessions not very enjoyable. Women often describe shooting or sharp pain after breastfeeding. These lesions may appear to be hardened milk that is obstructing milk flow. In actuality, their cause is more complicated than that. The pain associated with nipple blebs is due to blockage of milk at the surface of the nipple due to inflammation within the milk duct.  

Often, you may be able to start with some at home treatments to provide temporary relief from your symptoms. However, most women require prescription medications and professional advice on how to reduce their overproduction of milk. It is wise to reach out to a lactation consultant, breastfeeding medicine doctor or your primary care physician if you are experiencing a painful milk blister. 

Thrush is Not the Answer 

Before breastfeeding medicine became a specialty, breastfeeding mothers often received treatment for yeast infection on the breasts. Lactation consultants as well as pediatricians would often recommend treatment of nipple blebs with an anti-fungal cream or Gentian Violet.

Milk blisters or nipple blisters / blebs appear as a white or yellow dot on the surface of your nipple. For a long time, people believed that the cause of these blisters was due to a yeast infection.  However, newer research in the area of lactation disproves that theory. Nipples are very vascular, which means they have lots of blood flow, and yeast is not able to grow well in those conditions.  Similar scientific research found that the root cause of nipple blebs is due to inflammation of the milk duct. 

Therefore, I recommend that you avoid anti-fungal medication use on your nipples. 

Causes of Nipple Blebs 

When this white spot shows up on your nipple, you may believe that the problem is due to something that is wrong with the nipple itself. On the contrary, the problem starts deeper than the nipple itself. The source of the white dot is actually due to inflammation inside of the milk duct itself. The lining of the duct sloughs off and collects at the surface of the nipple. 

Additionally, the cause of inflammation in the duct is typically due to an imbalance between how much milk is in the breast and how much milk is removed. This is most often due to the oversupply of breast milk. When the milk ducts can’t hold all of the milk, it leaks out into the breast tissue. This milk then combines with bacteria in the breast tissue and leads to inflamed milk ducts. This leads to sore nipples due to milk blebs. 

What about a poor latch?

Poor latch is the root cause of a lot of nipple pain, but current research shows that it is not likely the cause of nipple blebs. Even though a poor latch can cause trauma to the nipple, this does not lead to a milk blister on the surface of the nipple itself. 

As we talked about earlier, ductal inflammation is the root cause of this nipple problem. An overabundant milk supply plus mammary dysbiosis (bacterial overgrowth) leads to these pesky causes of breast pain. 

How to Treat Your Milk Blister 

• Topical steroid cream: Milk blisters require a stronger topical steroid cream than you can purchase over the counter. You will need to see your doctor in order to get a prescription for the cream. This is where a breastfeeding medicine doctor like myself can be very helpful. 
• Sunflower lecithin:  While not all supplements have been proven to be helpful in breastfeeding mothers, this is an exception. Sunflower lecthin is an over the counter supplement that causes your breast milk to be emulsified and therefore less “sticky.” 
• Treat the Underlying Cause:  A lactation consultant can guide you on how to decrease your milk supply if you are experiencing oversupply of breast milk. A breastfeeding medicine specialist can treat you with antibiotics for mastitis if needed. 

Nipple blebs can take weeks to a month or more to resolve. 

What you should NOT do to treat a blocked nipple pore 

No matter how tempting it may be, you should not pop or stick a needle in the milk blister to remove it. This does not solve the problem and it can lead to further complications. You will increase your risk of infection by traumatizing the area. 

Additionally, the milk blister will keep coming back if it is not treated appropriately. 

Please also avoid using gentian Violet, anti-fungal cream or all purpose nipple ointment on the lesion. None of these things will treat the problem and may possibly cause further irritation or other complications of the milk pores. 

Instead, you should treat the underlying inflammation by taking ibuprofen and using a  cool compress on the area of the milk blister. 

Additionally, you need to treat your milk oversupply by cutting back on pumping sessions or cutting out pumping all together. Instead, you need to offer regular feeding sessions at the breast. You may also need to do some block feeding in order to decrease your milk production even more. 

When to Call the Doctor

According to the Academy of Breastfeeding Medicine’s updated protocol on mastitis that was published in 2022, nipple blebs are part of the mastitis spectrum. Both conditions have the same root cause. Mastitis is simply known as inflammation of the breast. It is on a continuum of simple inflammation all the way up to full blown breast infection. 

If you are experiencing symptoms of mastitis with or without a nipple bleb, you need to reach out to a physician for help. The symptoms of mastitis include flu-like symptoms, redness of an area of the breast and pain with breastfeeding. Some women also experience fever with mastitis.

Antibiotic ointment won’t help with mastitis as the problem is deeper in the breast tissue. Often, women will require an oral antibiotic if they have mastitis. If we catch it early, a breastfeeding medicine physician can often help you treat the inflammation before it becomes a full blown infection. 

What is Breastfeeding Medicine?

Late in 2023, the breastfeeding medicine board exam was offered for the first time. In order to be eligible to sit for the exam, a doctor needs to be actively involved in directly caring for lactating mothers. Additionally, we need to have had experience in making high level medical decisions for breastfeeding dyads. 

As a result of that exam, I was among the first 100 doctors in the US and Canada to become board certified in breastfeeding medicine. With this expertise, I am able to provide a higher level of care for mothers who are experiencing complications with their breastfeeding journey. 

If you are at this stage of your life, I would love to support you on your breastfeeding journey. In order to be the first to know about our upcoming breastfeeding support program, click the link below to get on our email list. Our weekly newsletter is also packed with breastfeeding tips and tricks. 

© 127 Pediatrics, March 2024