Treating a bleb (also known as a milk blister)
By Cordelia Uys, NCT Breastfeeding Counsellor
A bleb, also know as a milk blister, is a white, yellow or clear spot at the tip of a mother’s nipple. Women with milk blebs experience intense pain in the nipple, just behind it, and shooting pain deeper into the breast. It’s often described as nursing or pumping through a shard of glass.
Milk Blebs:
We used to think that blebs were simply blocked pores, filled with trapped milk, in one or more nipple orifice. But according to the updated Academy of Medicine (ABM) Protocol #36, milk blebs are now thought to be primarily an inflammatory condition, not just a blockage. A milk bleb occurs when inflammatory cells from inside the milk duct extend to the nipple surface and become lodged at or near the nipple pore. So the spot you see is often the result of inflammation, not simply milk ‘stuck’ behind the skin.
What causes Milk Blebs?
Milk blebs are often associated with inflammation within the breast and ducts. Factors that may contribute include:
• Hyperlactation (oversupply)
• Recurrent breast inflammation
• Excessive pumping
• Trying to constantly "empty" the breast
• Aggressive breast massage
Katrina B. Mitchell, an American breast surgeon and IBCLC Lactation Consultant says the following
Massage of the breast and manipulation of blebs causes bleeding and worsened tissue swelling. She believes pumping, particularly with an incorrectly fitting breastshield or with the vacuum set too high, increases the likelihood of getting blebs.
She is adamant that unroofing blebs with needles promotes more inflammation and can result in permanent scarring.
If you have a bleb that has caused milk obstruction in your breast, she recommends:
Alternate applying heat and cold.
Take paracetamol and ibuprofen.
Seek therapeutic ultrasound.
Ask your GP for a light steroid cream.
And take sunflower lecithin regularly.
Dr Thomas Hale: ‘Topical application to the nipple is generally approved by most authorities if amounts applied and duration of use is minimized. Only small amounts should be applied and then only after feeding; larger quantities should be removed prior to breastfeeding. 0.5% to 1% ointments rather than cream are generally preferred.’
Another source https://www.sps.nhs.uk/articles/safety-in-lactation-topical-corticosteroids/ recommends cream rather than ointment, so it probably doesn’t matter too much which is used.
Katrina B. Mitchell says the cream or ointment should be applied ‘several times a day.’
from Katrina B. Mitchell’s paper: https://www.nccwebsite.org/content/documents/courses/Breast%20conditions%20during%20lactation.pdf
Sunflower lecithin
In general, if you suffer from blebs, taking sunflower lecithin is a good idea:
http://kellymom.com/nutrition/vitamins/lecithin/
Ultrasound
It is also possible to have ultrasound treatment to clear blebs: https://www.cordeliauys.co.uk/therapeutic-ultrasound
Other helpful strategies
Continue feeding your baby normally
Feed on demand rather than trying to empty the breast
Reduce unnecessary pumping
Use ice for comfort and inflammation
Consider anti-inflammatory medications when medically appropriate
Address any oversupply issues
Work with an IBCLC to identify the root of the inflammation
What not to do
Do not attempt to pierce or lift the skin over the bleb
Several outdated sources recommend using a sterile needle to pull away the skin on top of the bleb. However this can make the situation worse as it can cause scarring and can lead to infection.
Tiffany: ‘I had lots of blebs until I took lethicin. I used to use a sterile needle to lift the bleb away and the blockage would clear immediately. However, this once caused an infection which was nasty.’
Katie: ‘I also popped my bleb as I couldn’t shift. I was pleased as punch for 48 hours before I developed a HORRIFIC infection which resulted in pus coming from the duct.’
Avoid aggressive massage
Avoid excessive pumping to ‘clear it’
Avoid repeated attempts to empty the breast completely