A milk blister, also known as a bleb, appears as a small white, clear, or yellow spot directly on the nipple opening. This condition occurs when a tiny milk duct becomes blocked, causing sharp, localized pain, particularly during milk expression or feeding. Though highly uncomfortable, a milk blister is common for breastfeeding individuals and is typically manageable with appropriate care. This article explores the different forms of milk blisters, their causes, and practical steps for treatment and prevention.
Understanding Milk Blisters and Their Causes
Milk blisters generally fall into one of two categories based on the blockage’s composition. The first type is a true bleb, where a thin layer of skin grows over the opening of a milk duct, sealing it shut. The second type involves a hardened plug of milk fat or cellular debris that blocks the duct from within. Both forms prevent milk from flowing freely, leading to the characteristic pinpoint pain.
The root cause of these blockages is often inflammation within the milk duct system, referred to as subacute mastitis or mammary dysbiosis. Factors contributing to this inflammation include hyperlactation, or an oversupply of milk, which causes pressure and congestion in the ducts. External pressure on the breast, such as from an underwire bra, a tight seatbelt, or sleeping on the stomach, can also compromise duct integrity and milk flow. While a poor latch may not directly cause the bleb, it can lead to friction damage or contribute to incomplete milk drainage, worsening the underlying issue.
Immediate At-Home Relief Strategies
The first step in treating a milk blister involves using moist heat to soften the skin and loosen the blockage. Apply a warm, moist compress or soak the nipple in warm water for five to ten minutes just before a feeding session. A warm Epsom salt soak, prepared by dissolving one to two teaspoons of Epsom salt in one cup of warm water, may help draw out the obstruction.
After applying heat, feed or pump frequently to maintain milk flow. Start the feeding session on the affected side, as the baby’s strongest suction occurs at the beginning of the feed, maximizing pressure on the blockage. Experimenting with a different feeding position, such as a “dangle feed” where gravity assists milk removal, can help direct the baby’s suction toward the bleb. Gently massaging the area behind the blister toward the nipple during a letdown can also encourage the plug to pass.
To further soften the skin covering the bleb, apply a small amount of olive oil or coconut oil to the nipple between feedings. This lubrication can be applied via a cotton ball and left in place in the bra for several hours. These non-invasive methods focus on encouraging the natural release of the blockage without causing further damage.
Addressing Persistent or Stubborn Blebs
If non-invasive strategies do not resolve the blister after a few days, a more targeted approach is necessary, ideally after consulting with a lactation professional or healthcare provider. A persistent bleb may require the sterile unroofing of the skin layer covering the pore. This procedure involves using a clean, sterile needle or lancet to gently lift the dead skin, but should only be attempted under professional guidance due to the risk of infection and tissue trauma.
A healthcare provider may prescribe a topical steroid cream, such as triamcinolone, to reduce the local inflammation contributing to the blockage. If the underlying cause is persistent ductal inflammation, anti-inflammatory medications like ibuprofen can manage the pain and swelling. Note that a white spot is rarely due to a fungal infection like thrush, so antifungals are typically not the first course of action.
Home treatment should be stopped immediately if signs of a worsening infection appear. Warning signs include a fever, flu-like symptoms, red streaks radiating from the breast, or a warm, hard lump that does not soften after feeding. These symptoms may indicate mastitis, a serious inflammation that requires prompt medical evaluation and potentially prescription antibiotics.
Preventing Recurrence
To prevent milk blisters from returning, the focus should be on optimizing milk drainage and reducing inflammation. Consulting with an International Board Certified Lactation Consultant (IBCLC) is beneficial for evaluating latch technique and ensuring the baby effectively removes milk. Correcting a shallow latch or adjusting a pumping flange size can eliminate friction and pressure that lead to bleb formation.
Dietary supplementation with sunflower lecithin may help reduce the stickiness of milk fat, making the milk less likely to form hardened plugs. The suggested dosage is 1,200 milligrams taken three or four times per day. Ensuring that bras and clothing are not too tight is also important, as chronic pressure on the breast tissue can restrict milk ducts and contribute to congestion.