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