A patient came in yesterday describing nipple/areolar pain at a "10-15" at latch-on, 5-6 at rest, on a scale of 0 to 10 (where 0 = no pain, 10 = most imaginable). She said she had two areas of exquisite pain on her nipple, both at the 11 o'clock position. The larger one was a small, darkish area approximately 1/8 to 1/4 mm on the areola, situated approximately 2 cm up from the nipple, which she said felt "raw" although it appeared unabraded. The other was a smaller, dot-sized area (approx. 1/10 mm) on the nipple itself, undifferentiated by any color change from the surrounding tissue, which she said felt like "an open nerve." The dot on the nipple I considered to be a possible milk blister, based on her description of the pain, and yet it didn't look remarkable in any way. I call it a "dot," but it looked to me like a normal ductal opening, possibly slightly swollen, but possibly not (since I didn't get a chance to see the geography of her nipple tissue before the onset of pain). Patient describes pain as existing prior to delivery and initiation of bf. I don't think I clearly differentiated between the two to discover if the pain of the lower area also began before breastfeeding. I helped the baby to achieve a deep areolar latch. The woman said that the pain fell to 3-4 (lower than before the baby had latched on, which she had described as a 5-6 at rest). This is her third baby, almost her first bfed, since the other two were only nursed in the immediate postpartum period. Would anyone have gone in with a needle in the absence of any visual sign of a milk blister? Would you, as I did, have sent the woman home with instructions to achieve a deep areolar latch and wait to see if she healed? Does anyone have a good explanation for what this woman presented with? BTW, she had an accessory ductal opening or nipple which let down milk simultaneously with let-down at the main nipple, at the 12 o'clock position on her areola, approximately 4 cm above the nipple. The amount, appearance, and timing of the fluid causes me to believe it was not proceeding from a Montgomery's gland. Arly [log in to unmask] MS, CLE, IBCLC