We see blebs (Lawrence's term for it has the advantage of brevity !) every so often in our practice. Down Under the common term for them is milk blisters or milk under the skin. Sometimes we see mothers who have blisters on their nipples - from sheer friction! - from using nipple shields or from babies who have such poor sucking actions that they cause a great deal of movement of the nipple in the babies' mouths. This means that internationally we are using the term "blister" to describe two different situations - with the first one, skin simply overgrows a duct opening on the face of the nipple (no friction is involved), and with the other situation, damage due to friction is being described and there is no duct opening being blocked off. It does not seem reasonable to us to continue using the word "blister" when this is so - there are enough confusions to find a way through as it is! "Blister" also has conotations suggestive of burns and friction. "Milk under the skin" was the term provided by Mavis Gunther early in this century - this describes the condition well, but is rather unwieldy. When I was in the USA in February it was very interesting to find that at least some American practitioners quite categorically advised against breaking the skin overgrowth on the nipple. In Oz it has been accepted practice to do so for many years, and seems to give immediate relief to the mother. Women get quite adept with a flamed (to sterilise) needle point when they are dealing with a recurring problem. To start with though, many women want their doctors to break the skin. (After some of these less than pleasant experiences, mothers are more inclined to do the job themselves!) If the skin is broken early rather than later, there is less likelihood of plugged ducts and "spaghetti milk" forming behind the bleb. If this does happen, however, and is not particularly resolvable with ordinary simple measures, we often advise that the mother see a physiotherapist for ultrasound treatment of the breast. Even with women with very nasty full blown cases of "caked breast" (where the whole breast is one solid mass of blocked ducts) one ultrasound treatment will painlessly resolve the whole mess! It's quite miraculous every time! Some women will go back for a second ultrasound treatment twelve hours after the first as "insurance" but this does not seem necessary with 99% of them. Robyn Noble and Anne Bovey, Brisbane, Australia