Non-stick dressing and other wound covers

Should I cover my damaged nipples?

Nipple damage heals faster when kept moist. Covering the damage keeps it moist and clean and keeps wound care products in place on the damaged area. There are many covers available, but we recommend non-stick dressings. Mothers can buy large pieces and cut them into 3-centimetre (1-1/2-inch) squares. They are applied right after breastfeeding and removed just before. If the damage is too painful to use a dressing, mothers can use a breast shell, which prevents anything from touching the nipple over the wound care product. Mothers with this much pain should consider that they may have an infection of their nipple damage. Plastic film is not recommended for nipple damage.

A) Describing the need for wound covers

Nipple damage tends to be dry and keeping it moist (moist-wound healing) has been shown to speed healing. For this reason, the types of wound care products (products) (i.e. purified lanolin, hydrogel dressings, antibiotic ointment, or medicated honey) used to treat nipple damage add a small amount of moisture.

Products need covers to:

  • Keep the product:
    • In place on the damaged area.
    • Moist.  
    • Clean.
  • Keep the damage from sticking to a bra or clothing. 
  • Prevent air-drying.

B) Non-stick dressings

1) Describing non-stick dressings

There are many covers available for damaged skin. We have found the best dressing for covering nipple damage is a non-stick dressing such as a Telfa™ pad. It is made of material similar to the lining of an adhesive bandage (plaster; bandaid).

  • Do not buy dressings that are adhesive or sticky, as removing them numerous times each day to breastfeed or express can cause skin irritation.
  • It is cheapest to buy a big piece of non-stick dressing and then cut it to a size big enough to cover the nipple and stay in place between feedings; this is about 3 centimetres (1 1/2 inch) square.

2) Using non-stick dressings

Non-stick dressings are put in place right after breastfeeding or expressing and removed right before. 

We recommend dressings are changed at every second feed. This is roughly four times in 24 hours. This should change to every feed if:

  • Mothers leak frequently.
  • There are signs of infection such as:
    • Discharge on the dressing.
    • Increasing or severe pain.
    • Increasing redness around the damage.

A non-stick dressing can also help keep steroid cream from being rubbed off when treating eczema or opened milk pimples.

C) Breast shells

A breast shell for tender nipples.

1) Describing breast shells

Breast shells are plastic discs that are kept in the bra. A breast shell has two parts. One is doughnut-shaped and is placed on the breast with the hole over the nipple. The other is the cover, which has holes to allow air to circulate.

There are two types of breast shells; one for inverted nipples and one for sore nipples. They differ in the size of the hole with the ones for sore nipples having a larger hole. There is no evidence supporting the use of breast shells to fix inverted nipples. The one for sore nipples is designed to allow for air-drying nipples, but this is no longer recommended. 

If a mother's nipple damage is too painful to use a non-stick dressing or allow anything to touch the nipple, mothers can use a breast shell instead as a cover for purified lanolin, an antibiotic ointment, or medicated honey. They will not easily keep hydrogel dressings or medical grade honey pads in place.  

We have not had much need for these, but they are an option.

2) Risk of breast shell use 

Breast shells can irritate the parts of the areola and breast that they touch, because the plastic can keep the skin too moist.

Wearing a tight bra can result in excess pressure on the breast shell and areola. This may be the case if you notice a tender, red circle on the areola.

Breast shells can also result in swollen, firm, nipples and areolas, which can worsen the baby’s latch and increase nipple pain and damage. Stop using them if you notice this.

D) Wound covers that are generally not recommended

1) Silicone pads

Commercial silicone pads are marketed for nipple pain, but there is little research on their use with nipple damage. Unlike non-stick dressings that are regularly changed to limit the risk of infection, silicone pads are meant to be reused. They are also marketed to prevent leaking.

We have seen silicone pads cause a yeast infection and an allergic reaction. They are closely applied to the nipple and areola and may keep the area too wet.

2) Plastic film

While damaged nipples should not be exposed to direct air, keeping them too wet can damage the skin around the damaged area and slow healing. For this reason, plastic film should not be used.