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

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