Breastfeeding: White pimple on nipple

I have a white "pimple" on my nipple, which my doctor says he could drain with a needle. I also have had discharge from my right breast off and on for many months and think I may have a fever. It is very painful, especially the week before my period. What can I do to help resolve this condition?

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Kathy Kuhn

Kathy Kuhn is a registered nurse who has been working with breastfeeding families since 1981. She has been an International Board Certified... Read more

See your physician for an exam and find out whether you have a plugged duct, milk blister or an abscess along with a case of mastitis. All three can give a pimple-like appearance.

The most common contributing factor for these conditions is a back up of milk in the breast (milk stasis). Milk statis can be caused by poor position and latch, abrupt reduction in the amount of breastfeeding, breastmilk oversupply, irregularities in the breast from previous surgeries or injuries, or a too-tight bra.

Plugged ducts and milk blisters are generally painful and when they occur on the tip of the nipple can look like a pimple. Milk blisters can be white or clear and may be caused by a plug of thickened milk or skin over the end of a duct. Plugged ducts are literally a blockage in the milk duct, usually of thickened milk, that prevents or greatly reduces milk flow.

To treat both, apply warm compresses to the affected area just prior to breastfeeding or milk expression. You can do this in the shower or try soaking your breast in a sink of warm water. Massage the affected area gently, working toward the nipple.

Plugged ducts and milk blisters increase your risk for mastitis, a breast infection, that could cause the fever. Mastitis has a sudden onset with flu-like symptoms, fever and a very sore breast. It’s usually treated with antibiotics, rest and frequent breastfeeding to promote milk drainage. If you aren’t able to breastfeed, milk expression with a high quality rental breast pump would be the second choice. (Plugged ducts and mastitis should feel more comfortable after feeding or pumping.)

However, because of the drainage and long-term pain, it seems more likely that you have an abscess, which can occur after an untreated or under treated bout of mastitis. If your breast has been painful for many months, it's possible that you had mastitis and didn't realize it or seek treatment.
An abscess is a localized collection of pus, thus the pimple-like appearance and is usually treated by draining either with a needle or surgically with a small incision. It’s possible and usually preferable to continue to breastfeed even when an abscess has occurred and has been drained. The reason your breast may be more painful before that time of the month is because of premestrual swelling that may increase the pressure in the breast and contributing to milk back up.

Get a referral from your physician for a board certified lactation consultant; she’ll help you maintain breastfeeding through any procedures your physician recommends and the recovery period. A lactation consultant would also be able to assess what may have caused the problem.

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