How nipple damage heals

Is my nipple healing?

All nipples heal but it never seems quick. The speed of healing depends on the depth, size, and shape of the damage. If the damage is just on the surface, as with a scab, it generally heals within two weeks. Deeper damage, such as a crack, takes about 4 to 8 weeks to heal once the damage is properly treated, and large ulcers (circular damage) take up to 12 weeks. There are several stages. At first, yellow, dead skin may appear over the damaged area. The area then cleans itself, leaving a clean pale-pink centre. The hole gradually fills with a red healing tissue and begins to look drier and bumpy. Pain steadily decreases and skin covers the damaged area until the area is healed. The last of the pain is settled two weeks after complete healing. There are a number of reasons for the rate of healing to slow or stop and these should be addressed. Most nipples look normal a few months after healing. Rarely a nipple may be left with a scar or a different shape.

A) Describing how nipples heal

Mothers with nipple damage must ensure it heals. Healing happens in various stages. To speed the healing of nipple damage, it is best kept moist by being treated with appropriate wound care products and coveredMothers must also address the cause of the damage.

We generally encourage mothers to breastfeed throughout the healing process. Expressing can be used when it is too painful to breastfeed, when the nipples are not healing, which can happen on rare occasions, or if the damage is increasing. Mothers should also prevent further damage and optimize their health.

It may be hard to see changes in your nipple as it heals. Some mothers will take a picture of the nipple each week to see the changes and to ensure the healing is progressing as expected. Damage that is healing becomes less painful each week.

B) How long nipples take to heal

How fast nipple damage heals depends on the depth of the damage. It is of course, never as fast as you would like.

1) Healing superficial damage

If the damage is mild with only surface blistering or scabs (Stage 2), it generally heals within two weeks. Latching the baby may still be tender for another two weeks, but the pain is much less intense and quickly decreases.

The risk of nipple damage infection and mastitis is also lower if the damage is superficial.

2) Healing deeper damage

Deeper damage with cracks and ulcers (Stage 3) poses more of a challenge. It:

  • Takes longer to heal (Abou-Dakn 2011; Neto 2018).
  • Is more painful (Abou-Dakn 2011; Neto 2018).
  • Is more likely to become infected.

Smaller wounds heal faster than larger ones. Wounds under 2 millimetres may easily heal in 2 to 4 weeks. 

Larger damage in the shape of a(n):

  • Crack (linear damage) takes about 4 to 8 weeks to heal.
  • Ulcer (circular damage) can take 6 to 12 weeks.

The good news is that the pain steadily declines and it is rare for the damage to stop healing or increase.

C) Stages of healing

Healthy granulation tissue is present in the middle of the wound (ulcer) and a white skin ring covered the edges and is moving toward the centre.

The gallery at the bottom of this FAQ shows how three nipples healed.

Deep damage goes through six stages as it heals:

1) The damage shows itself

Skin over the area that is no longer viable dies and appears yellow.

2) The damaged area cleans itself

Dead skin increases the risk of infection and the body quickly works to separate it from healthy skin, leaving a clean pale-pink centre. 

3) Granulation tissue forms

The body fills the damage hole with a red healing tissue called granulation tissue. This stage is the longest. It seems nothing is happening, but the granulation tissue is working hard at filling the damage (granulating).

The damage will not change in width during this time but it becomes less deep and the granulating tissue matures. It changes from looking shiny or wet to dull or dry and bumpy,  even though it is being kept moist. Sometimes it even grows a little higher than the edge of the skin. This is normal.

The pain steadily decreases as the granulation tissue covers the sensitive nerve endings.

4) The skin covers the damaged area

Once the granulation tissue has created a healthy base, the damaged area starts to cover itself with skin. The skin cells start to move in from healthy skin at the edge, work their way across the area, and eventually cover all of the granulation tissue.

When this starts, a white ring can be seen to form at the edge of the damaged area. It grows toward the centre and the area covered by granulation tissue gets smaller.

Skin cells may also be able to grow out of any remaining sweat glands

5) The damaged area is covered

The new skin is very thin and the blood underneath can shine through. This may make the healed area look slightly pale or blueish. It is normal to have a little pain with latch for a few weeks after the damage is healed. This is new skin and it needs more time to settle.

The healed area may be indented instead of level with the rest of the nipple.

6) Fully healed

Over the next few months, the pale or bluish areas turn pink and indentations fill in. Structures underneath are continuing to heal.

Permanent changes are not common and after six months, it is often hard to see any scars or abnormalities. The deeper the damage and the longer it takes to heal, the more likely there will be scarring.

Permanent scars may appear as:

  • A fine white line.
  • A pale area.
  • A depressed area.
  • A deformed nipple.

D) When nipple damage is slow

Nipple damage healing can be delayed by:

  • Not addressing the cause of the nipple damage.
  • Developing:
  • Have an allergic reaction to preparations they are using.
  • Exposing the nipples to air. 
  • Further damage from sticking to nipple wound covers.

Healing of nipple damage may be slower or more likely to be complicated by infection if the mother:

  • Is diabetic.
  • Has a weakened immune system because of medication or illness.
  • Has low levels of red blood cells (anemia).
  • Is not eating enough protein.

In rare cases, healing of nipple damage stops with no identifiable cause. In this situation, mothers can consider using medical grade honey.

Another option is expressing at least at every second or third feeding. Expressing can:

  • Speed healing.
  • Limit further damage from breastfeeding.
  • Reduce pain.

Each of these should continue for two weeks after the nipple has resumed healing.

References

Abou-Dakn M, Fluhr JW, Gensch M, et al. Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol. 2011;24(1):27-35
 
Neto CM, de Albuquerque RS, de Souza SC, et al. Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma. Rev Bras Ginecol Obstet. 2018 Oct 29
 

Healing nipple damage

The following nipple wounds were treated with purified lanolin and a non-stick dressing. All the mothers chose to continue breastfeeding as the wounds healed.