Developing nipple damage

How did I get damaged nipples?

Nipple damage can be caused by the trauma of normal breastfeeding but is more likely if there are additional factors. It is important to identify and fix the cause of nipple pain as it often precedes skin damage. Early nipple damage follows a certain pattern. Mothers can also develop nipple damage after a period of pain-free breastfeeding. This can be for a number of reasons. Most superficial damage is healed within two weeks. On occasion, deeper nipple damage will develop. The pain will continue to increase until effective treatment is started and the skin starts to heal. Nipple damage can lead to a bacterial infection, which is particularly painful. Nipple pain will clear a week or two after the damage has healed. 

A) Developing nipple damage

Some of the same problems that can cause nipple pain can also cause nipple damage. Nipple pain usually develops before damage. It is important to identify and fix the possible causes of pain in order to prevent the progression to damage.

The nature and severity of the problem and the nipples’ response to it will affect the severity of skin damage, it’s shape, and location.

Nipple infection with bacteria is especially associated with deep nipple damage as bacteria have properties that allow them to penetrate skin and damage it in the process. The body’s reaction to infection can further damage the skin through inflammation. 

The pain may increase or change if mothers develop infection or other problems such as nipple vasospasm.

B) The pattern of early-onset nipple damage

Early nipple damage caused by nipple compression.

The most common causes of nipple damage are also the causes of nipple pain soon after birth (early-onset nipple damage) and are roughly described as: 

  • Breastfeeding
  • Poor breastfeeding technique
    • Excessive breastfeeding
    • Poor positioning
    • Poor latching
  • The nipple and nipple root characteristics
  • The role of the baby
  • Expressing
  • The use of nipple shields

Because early-onset nipple damage is often related to the trauma of breastfeeding, it most commonly affects both nipples (Branger 2019). It may be more common in mothers with lighter skin colour (Branger 2019). 

1) Superficial damage  

Most superficial early nipple damage related to breastfeeding tends to follow a pattern (Nakamura 2018):

  1. The baby’s first breastfeed is painful.
  2. After the first feed, the nipple:
    1. Looks redder and more swollen than usual.
    2. May be blistered and possibly bruised.
    3. May look misshapen right after the baby comes off the breast.
  3. Scabs may develop within a day of starting to breastfeed.
  4. By Days 3 and 4 (Branger 2019):
    1. Latching pain is at its worst as the milk comes in and the breast and areola become harder.
    2. There may be blisters, scabs, and peeling.
  5. The pain decreases after Day 4.
  6. Scabs are healed by two weeks.
  7. The nipple may be tender for a further two weeks.

The least severe stages of skin damage are the most common. The less the degree of damage, the faster it heals.

2) Deeper nipple damage

A few mothers develop deeper nipple damage during the first week of starting to breastfeed. These will appear as damage in the shape of cracks or ulcers.

If the damage becomes infected, the nipple may look more swollen and red, the wound may leak pus that will stick to the breast pad, and the pain will increase. Mothers may also go on to develop mastitis or an abscess in the second week after giving birth.

C) Causes of late-onset nipple damage

Just as early-onset damage, late-onset damage can also be caused by nipple or areolar trauma. Causes include:

The nipple bottom can break open if a yeast infection is present.

Other skin changes can develop during breastfeeding. These are not related to trauma and their treatment depends on the cause.

References

Branger B; Breastfeeding Commission of the Pays de la Loire Birth Safety Network (France). Description of 101 cases of nipple cracks and risk factors via case-control study in eight units of a perinatal network. Arch Pediatr. 2019 Nov 26;S0929-693X(19)30192-7
 
Nakamura M, Asaka Y, Ogawara T, et al. Nipple Skin Trauma in Breastfeeding Women During Postpartum Week One. Breastfeed Med. 2018 Aug 3