Management of Lactation Complications – Nipple Blebs

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Myth:
    • Nipple blebs are caused by trauma from shallow infant latch
  • Science:
    • Blebs appear as:
      • Small white, yellow, or red blisterlike lesions on the surface of a nipple
    • They are inflammatory lesions that may occlude a nipple orifice:
      • They reflect underlying ductal inflammation and microbiome disruption with biofilm formation
    • Blebs are associated with:
      • Hyperlactation (oversupply)
      • Pumping (which alters the breast microbiome)
      • C-section births (which also alter the breast microbiome),
      • Other characteristics of individual variation in microbiome expression
    • Blebs are not related to infant trauma or latch in any way
    • Because blebs are very painful:
      • Moms often believe the infant has a poor latch or otherwise has contributed to the problem:
        • However, this represents an association rather than causation
  • Treatment:
    • Asymptomatic blebs do not require any specific treatment
    • Blebs causing milk obstruction warrant treatment:
      • To reduce underlying ductal inflammation and decrease the viscosity of milk
    • Sunflower lecithin by mouth:
      • Is effective for breastmilk emulsification and can help to both treat and prevent blebs
    • Therapeutic ultrasound can also be used to reduce breast inflammation
    • Symptomatic blebs occluding an orifice:
      • Should be treated with oral lecithin as well as a topical medium-potency steroid:
        • Such as 0.1% triamcinolone cream
    • Blebs should not be routinely unroofed with a sterile needle or other means:
      • As this may transiently relieve milk obstruction in an associated ductal orifice but will also cause local tissue trauma and can lead to scarring (Figure):
      • This scarring can result in permanent occlusion of the nipple orifice
    • Patients should be instructed not to attempt to squeeze out a bleb or pick at it with their fingernails, as this can cause bleeding and further trauma
Nipple bleb at presentation (A) and after chronic tissue trauma from frequent un- roofing (B).

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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