What are Damaged Nipples, and What does that Mean?
I never thought I would need to clarify this, but it is a question that comes up daily with my clients, and there are not crystal clear resources to help answer this question. Bad breastfeeding advice and support has been so normalized that people aren’t even sure if their nipples would be considered damaged. Then, they are too embarrassed to ask for clarification and understanding because they think it’s a dumb question.
It is not a dumb question!
What are Damaged Nipples?
Damaged nipples are a common issue for breastfeeding parents, but many are just unsure if their own nipples are damaged or if what they are seeing is normal and expected. Often, a root cause of this confusion seems to stem from an encounter with a health care provider or lactation consultant who viewed their nipples and did not explicitly say, “Hey, your nipples are damaged.” This causes parents to wrongly assume that their nipples are, in fact, normal for breastfeeding, and to allow the damage to go unchecked and untreated until it finally reaches a breaking point.
What should your nipples look like when you are breastfeeding?
Like regular nipples.
Seriously. I'm not joking here.
Your nipples when you are breastfeeding may…
Be larger.
Be darker
Have more prominent erectness.
Have more noticeable glands on the areola.
Appear more elongated during times of more frequent nursing or pumping.
If your nipples were previously flat or inverted, there may be some changes to their shape as tissue adhesions may break down during pregnancy and lactation allowing the nipple to stay more erect.
The skin should be intact, and well moisturized. There should be no bruising or discoloration.
I know you may have already shown your nipples to a lactation consultant or health care provider who said your bleeding, cracked, discolored, painful nipple is just what happens when you breastfed, particularly when you pump. This is not accurate or helpful information! Nipple damage is common, but it isn’t normal, is a great article to review for truly factual information.
Can you have nipple pain without damage?
Potentially. Nipple pain that is occurring only during a particular activity that resolves immediately could occur without damage. For example, using a 27 mm flange could cause pain during the pump session that resolves when you stop pumping immediately with no lingering pain or sensitivity, and if you rarely use this, and there is no pain and sensitivity any other time, it is unlikely to be damage. This is extremely rare, though, as most parents won’t feel the pain until after damage has occurred and tissue trauma can occur quite quickly.
So what constitutes nipple damage or trauma?
Cuts
Cracks
Bleeding
Blisters
White or Yellow Plaque (build up) on the nipple
Swelling
Bruising
Chapping
Extreme Dryness
Sensitivity when clothing or water touch your nipples
Raw skin
Discoloration of the nipple or areola from excessive rubbing against the skin
Nipples that feel like there has been a change in density or texture (typically related to swelling)
Pain that happens outside of a pump session or nursing session (pain during is also a concern, but if isolated to the activity and no lingering tenderness after, it’s likely not damaged, YET).
These concerns indicate nipple damage whether they are present on the nipple itself, the base of the nipple where it meets the areola, or the areola.
Where does nipple pain and damage come from?
Nipple pain and damage comes from some type of trauma to the nipple or from an infection of the nipple or breast. The only way we can accurately identify the cause of the damage, which is key to creating the right plan to achieve healing, is to fully assess this situation.
A full history, visual assessment, and careful monitoring of the careplan to assess for those tricky underlying infections and conditions that sometimes don’t appear obvious is important.
What should you do if you have nipple pain or damage?
You need to get an assessment of your full breastfeeding situation in relation to your nipple damage so that we can determine what is causing the issue, and tailor your plan to fix the damage for good. When I’m assessing someone for nipple damage, I am looking at:
A functional oral assessment of your baby to determine if their latch could be contributing and to determine if a higher level of care is needed.
A full pumping history to determine if the pumps/flanges you are using could be causing damage and a determination.
Screening for health concerns that could contribute to a higher propensity for nipple pain to identify the cause unrelated to the actual breastfeeding experience.
Is it actually possible to get to a pain-free breastfeeding rhythm without weaning from nursing or pumping?
I know when your nipples are in pain, and the damage is actively ongoing, it is hard to imagine that it can ever be resolved without stopping entirely. I assure you, though, if you do an assessment, actively work your care plan, follow through with recommendations for medical care that may require you to actively advocate for yourself, and work towards your goals, there is a very good chance of success. Sometimes, there may be reasons for the pain that we can’t resolve, but we can actively identify the root causes so that you can make the choices that are right for you.
