Types of nipple damage

What are the types of nipple damage?

Nipple damage is usually easy to see, especially right after the baby lets go of the nipple. Sometimes the damage is hidden in the folds of the nipple and can be found by gently pulling the nipple to the sides and up and down to stretch the folds. The central areola can also be gently squeezed to check the nipple face. Nipple damage is classified by depth, ranging from Stage 1 to Stage 4. It can also be described by shape and location.

A) Checking for nipple damage

Nipples are covered with skin. If traumatized, the skin can break down to varying degrees (become damaged). Most nipple damage is easy to see, but sometimes it is hidden in the folds of the nipple face, sides, or bottom, making it important to thoroughly examine the nipple.

Some damage is best seen right after the baby lets go of the nipple. Folds in the skin on the sides of the nipple can be examined by gently pulling the nipple to the sides and up and down to stretch the folds. The pinch test can help when examining the face of a nipple, especially if it is shy or dimpled.

B) Describing nipple damage

A scab (stage 2 damage).

Nipple damage can be described by:

  1. Depth
  2. Shape
  3. Location

1) Describing nipple damage by depth

The skin has two layers: the epidermis and the dermis. The epidermis is the top layer and is a waterproof barrier. The dermis is under the epidermis and contains the hair follicles and sweat glands. It is held together with tough bands of tissue (connective tissue).

Fat and more connective tissue may be found under the dermis, and below these are muscle, ligaments, tendons, or bone.

There are four main depths of skin damage. The depth affects how long the nipple takes to heal.

Table: Nipple Damage Classification by Depth From Least to Most Deep

(Links to more information about the topics in the above table: compression lines.)  

We have only seen Stage 4 nipple damage once.

2) Describing nipple damage by shape

Damage can be described by the shape of the damage:

  • Cracks: a line-shaped area of damage
  • Ulcers: a circular area of damage

3) Describing nipple damage by location on the nipple

Damage can be on the nipple face, sides, or bottom.