well, the really frustrating thing to ME is, we really don't know for sure 
what these are, because noone has ever bothered to do a biopsy and put the 
tissue under a microscope and figure it out.

But the theory that makes the most sense to me after seeing scores of these, 
is that the wall of the duct rips near the opening (from a shallow latch, 
chewing, or a sudden yank to see what is going on in an older baby) and milk 
dissects into the tissue next to the duct, pushing the duct wall out the 
pore in a now blind pouch.  There are nerve endings in the distal part of 
the duct, so stretching them is extremely painful.

Unfortunately it appears the duct never heals to the original anatomy again. 
Once it is open, (which often must be done manually) you have to try and 
keep the edges from healing back together (which they "want"' to do) and you 
are left with a little white doughnut of a scar (visible, but usually <1mm 
across) when it is all done with.  This can take weeks, however.

I have found polysporin or fancy nipple ointment to both work as far as 
keeping the edges from closing...apply after nursing or pumping every time 
until no more tendedrness.

So---if it is one freak thing, the above will do it.  If there have been 
multiple blebs at different sites, then something needs fixed. (tongue-tie, 
shallow latch, yanking toddler)  I have seen one older baby who insisted on 
watching TV while nursing, (sitting next to mom!) so had mom's poor nipple 
stretched way out so she could turn to see the TV. (ouch)

Lecithen is theoretically helpful for recurrent plugs that do NOT involve 
blebs, as it emulsifies fats and supposedly helps keep blobs from forming. 
Plugs that occur with blebs are presumable due to stasis.

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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