Nipple blebs are a common cause of breastfeeding pain- those tiny white or yellow “pinhead” spots that appear on the nipple and can make feeding feel sharp or burning. According to the ABM Protocol #36 (Mastitis Spectrum, revised 2022), blebs are part of a broader inflammatory process within the lactation spectrum. When inflammation narrows the milk ducts, inflammatory cells can collect at the nipple surface, forming a bleb. Contrary to popular belief, these are not simply “clogs” or hardened milk that need to be popped.
Common symptoms
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Pinpoint white/yellow spot on the nipple pore
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Sharp, needle-like pain at latch or during pumping
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Localized tenderness and sometimes deeper, “back-pressure” fullness behind the pore
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They may accompany other mastitis-spectrum signs like congestion or recurrent “clogs.”
Treatments that align with ABM 36
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Do not unroof (don’t pop) the bleb. It traumatizes tissue and can worsen the narrowing.
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Reduce inflammation: Use ice between feeds and consider NSAIDs such as ibuprofen (consult your healthcare provider before use) for short-term relief. Heat can feel soothing but may increase inflammation- use sparingly if at all.
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Topical steroid: A moderate-potency 0.1% triamcinolone thinly applied to the nipple surface can calm inflammation (wipe off before feeds/pumps if desired).
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Oral lecithin (sunflower or soy, 5–10 g/day) may help decrease ductal inflammation and emulsify milk.
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Avoid harmful hacks: ABM advises against Epsom-salt suction soaks, castor oil packs, and deep/aggressive massage- all can macerate skin or worsen edema. Gentle handling wins.
Preventing recurrences
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Right-size pump parts and suction. Too-small flanges or high vacuum increase friction and swelling.
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Feed on demand- don’t chase “empty.” Over-removal can up-regulate supply and perpetuate congestion; manage any hyperlactation with a tailored plan (often prioritizing the less-full breast first).
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Consider targeted probiotics (e.g., L. fermentum or L. salivarius) if you’re prone to mastitis-spectrum issues, recognizing the evidence is mixed.
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Support the tissue: A well-fitting, supportive bra helps limit dependent swelling.
When to get help now
If pain is severe, the bleb persists for more than a few days, you notice spreading redness/fever (call your doctor right away!), or you have recurrent episodes, it’s time for a skilled assessment and a customized plan (pump fit, latch mechanics, supply regulation, and safe medication use). ABM 36 is a guideline; your care should be individualized!
We can help.
Our IBCLC team treats blebs every week and follows ABM-consistent care. Book a visit- virtual or in-clinic, and let’s get you comfortable, protect your supply, and keep feeding on track!