I agree that this seems to be the world's worst case of nipple blebs ... I
am cutting-and-pastig here an earlier post I made on this topic, with
permission by Dee Kassing (she of paced-bottle-feeding fame), which
describes in her own wonderfully clear way the
regimen she suggests for mothers suffering from intractable nibble blebs:

"Here's what I suggest for a "recurring" nipple bleb.  Personally, I think
that it really isn't "recurring", but more likely "never quite cleared up in
the first place."  I think that when that milk sits at the front of the
nipple pore, thickened, so it can't get out, then the milk behind it in that
particular duct also thickens as it sits there unable to move out.  Then,
eventually, the mother finds a way to get the white spot at the nipple pore
to go away, and she temporarily feels better.  I think she took the pressure
of the tissue at the nipple pore.  But that other milk that thickened as it
couldn't get out, is still there, just back farther in the breast where it
can't be seen.  Then as baby nurses a few more times, or another day or two,
he gradually pulls that toothpaste-thick milk down to the front of the duct,
and that thick milk puts pressure on the tissue around the nipple pore
again, and mom is in pain again.  But it's not a "new" bleb (at least, this
is my conjecture), but just more stuck milk finally making its way down the
duct.

"So I suggest that moms take a pain reliever (like Motrin) right before they
nurse the baby, preferably when there is another adult in the house to take
care of the baby after they've finished nursing.  Otherwise, if she is
alone, she can try to do this when she expects baby to take a long nap after
nursing.  She takes the pain reliever, so that it has time to get into her
system, and I warn her that what I'm suggesting will not feel good.  (So she
isn't cussing at me while she's in the tub, thinking I'm a complete moron.)
She breastfeeds, so there's the least amount of milk/pressure in the breast
as possible.  Then she gets in the tub, with the water high enough that she
can comfortably lean over and submerge her breasts.  She soaks them for 3-4
minutes, to let the heat help to widen the ductwork.  Then she starts at the
nipple and massages and expresses the nipple to move out any thickened milk
she can.  Then she moves back to the areola and massages and expresses a
strip about an inch wide, all the way around the breast.  Then she moves
back about an inch toward the chest wall, and again massages and expresses
any milk she can out the front of the breast.  She continues to move back on
the breast, inch by inch, constantly moving the milk towards the nipple.
(If she starts back at the chest wall, she's just running milk into the
blockage and increasing the pressure.)  I warn her that if she manages to
express any thickened milk, it is likely to feel unpleasant or even painful,
but that if she manages to get it out, she will feel much better afterwards.

"I also warn her of two more things:  1.  If she gets out a plug or
thickened milk, it is likely to look kind of stringy and clumpy and
cottage-cheesy in the water.  If you don't warn her and she sees this, she
will absolutely freak out.   2.  Then you must immediately reassure her that
if she doesn't see this in the water, but the pain/plug/bleb goes away/does
not return, then it won't hurt her baby to have swallowed it down.  It's
just breastmilk that lost some of its water and got thick, but it still has
all the antibodies and nutrients it ever had.  Otherwise, the mother's mind
immediately goes from "don't worry if you see this in the water" to "what if
the baby swallows that awful-looking stuff?".

"I suggest that they do this three nights in a row.  It very frequently
solves the problem.   Dee Kassing"
Back to Liz now.
The only thing I might add to this regimen is to suggest the mom use some
APNO on the affected nipple, to prevent bacterial infection, which has been
suggested in other posts as a confounder when moms have this really annoying
condition

-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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