Hi all, I have searched the archives for milk bleb and nipple bleb and have found some posts but none that state the most effective treatment. Please help with me with this woman who has been suffering with it for 2 1/2 weeks. This patient delivered 5 weeks ago and did not have any trouble with nursing except for mild nipple tenderness initially. About 2 1/2 weeks ago she began having general left breast aching and nipple soreness. She was given an antibiotic for possible mastitis and baby was put on nystatin for possible yeast. She did not finish the course of antibiotics because of a reaction and another doc took baby off the nystatin as there was no sign of yeast. Over the next couple of weeks she noticed a small white lump on nipple which has steadily gotten bigger. This bleb is present after the baby feeds and then recedes to a flattish, yellow, crusted spot on nipple which can not be removed. The breast pain was worse this past week and she again saw 3 different md's one of which called me and described what it looked like. I told him what my sources said about opening bleb with a sterile needle which he tried. At the time that he tried that the bleb was not fully engorged. He did not get any milk release afterward. This was very painful afterward for mom and she was on Darvocet. I was finally able to see this mom personally tonight. She states that her breast is slightly better today but still very painful. She has a constant aching in breast especially left lateral. I saw no redness, lumps, firm areas. I observed a feed and after nursing 10 min a very large white bleb was present on tip of nipple. This receded to the flat, yellow, crusty area after a short time. I have read in the archives that it is thought that yeast could be the cause. Do you think that it would be helpful to put her on a course of Diflucan? She has had this so long that I would like to get the fastest treatment possible for her. Does anyone think that the fact that the bleb keeps getting bigger indicate that it will spontaneously burst or should it be lanced when engorged like this? What is the best treatment for this? I gave her shells for comfort between feeds. I suggested warm soaks/compresses before feeds to try to soften the bleb. As she is not nursing often on that side because of the pain and now is seeing a decrease in supply I gave her a shield to see if that would make her more comfortable. I stressed to her that it is important to have baby feed freq or that she should pump. I apologize for the length of this post. I am trying very hard to find help for this mom. She so wants to continue but is becoming very discouraged. The OB doc is talking about lancing it tomorrow 5/23 so if anyone has thoughts about that being not the right thing to do would you email me please. Thanks so much for your help. I appreciate it very much. Sincerely, Jackie Proko RN, IBCLC mail to: [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html