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What is the White Spot on My Nipple?

In today’s blog, I’d like to do something different to usual and share a real case involving one of my recent patients. I conducted a postnatal and follow up consultation with this mother, and everything seemed to be going well until I received a message from her mentioning that she suspected she was developing a milk bleb. She was unsure about what to do, so while waiting for my response, she did some online research and came across conflicting information. Because the spot was on the areola instead of the nipple, she wondered if it might not be a milk bleb and decided to try popping it herself. 

She messaged me again to explain what she had done and expressed panic because she had read that it could become infected, leading to mastitis or something worse. So, in this blog, we will explore what a milk bleb is, it’s causes, how to treat it, and as usual, I will share my top 5 tips for prevention, empowering you with the knowledge to navigate this common issue with confidence. 

What is a Milk Bleb?

Milk blebs, often referred to as milk pearls, blocked nipple pores, or milk blisters, are blister-like fibrinous lesions that appear on the surface of the nipple or areola during breastfeeding and can result in orifice obstruction. The most common ones are the tiny white spots, but they may not always be white; sometimes it could be more of a pink or light-yellow colour, indicating possible infection.

They are caused by a blockage in the milk duct, which prevents milk from flowing freely. One thing to note is that the milk pearl is considered tip of the iceberg, indicating there may potentially be other issues deeper in the ducts. 

Milk blebs can be very painful and uncomfortable for breastfeeding mothers and can cause a burning or sharp sensation. 

What Causes Milk Blebs?

Not much is known about milk blebs, there are different theories, so let’s look at factors that can contribute to their development:

  • Milk duct blockage: A common cause of milk blebs is a blockage in the milk duct, which can occur due to a variety of reasons, including improper latch, infrequent feeding or pumping, or pressure on the breast.
  • Skin conditions: Certain skin conditions, such as eczema or psoriasis, can increase the likelihood of developing milk pearls. 
  • Oversupply: Breast engorgement, which occurs when the breasts become overfilled with milk, can lead to milk duct blockage and the formation of milk pearls. 
Managing a Milk Pearl

While milk pearls can be uncomfortable, they are usually treatable and shouldn’t cause damage to the nipple. There is still a lot of controversy about the best way to treat them, but there are some simple remedies you can try at home:

  • Warm compress: Applying a warm compress to the affected area can help soften the skin and loosen the blockage, making it easier for milk to flow. Make sure the water is warm and not hot to avoid any further issue, like mastitis. 
  • Soak the nipple: Soaking the nipple or affected area in a bowl of warm water might help soften the bleb. 
  • Gentle massage: Gently massage the affected breast can help break up the blockage and encourage milk flow. Be sure to massage clockwise and avoid the nipple to prevent further irritation. 
  • Breastfeed your baby: My first recommendation once you have removed the blister is to feed your baby straight away. Babies have a strong suction, and they can help clear up the blockage and relieve discomfort. If nursing is not possible, you can use a pump, making sure you’re using the correct flange size to avoid any further irritation. 
  • Keep it clean: Once the blister is removed (because you pop it or it pop out on its own), remember to clean your nipple just with water and soap, and to dry it with kitchen paper instead of a towel to prevent the area from any infections. 
My Top 5 Tips to Prevent Milk Pearls

Now we know milk pearls can occur unexpectedly, there are some steps breastfeeding mothers can take to reduce their risk:

1. Position and attachment: Ensuring a proper latch and positioning during breastfeeding can help prevent milk duct blockages because babies can remove milk easily.

2. Frequent feeds: Nursing frequently helps prevent engorgement and ensures milk flows freely, and for as long as they need. 

3. Manage engorgement: If experiencing engorgement, use techniques such as warm compresses and gentle massage to relieve pressure and prevent blockages.

4. Pump if necessary: If you need to pump because your baby is not managing to empty your breast, or because your baby is sick or you are not with your baby for any reason, make sure to express the amount of milk you need to feel comfortable and your baby’s needs. 

5. Do not clean your nipples: You don’t need to clean or wash your nipples every time your baby feeds, and you don’t need to use any creams. 

Summarising, milk pearls are very common, and although sometimes not very painful, they can cause discomfort for breastfeeding mothers. By understanding the causes, treatment options, and prevention strategies, mothers can effectively manage milk pearls and continue their breastfeeding journey with confidence. Remember, if you are not sure what is happening, seeking support from an IBCLC lactation consultant can provide additional guidance and support in addressing your individual experiences.  

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