Blisters on the nipple typically happen from either friction or too much vacuum (suction). Where the blisters are on the nipple usually tells us which cause is most likely. If it's on the side of the nipple, it's probably from friction. If it's on the end (tip) of the nipple, it's probably from too much vacuum.
Friction blisters are caused by the nipples rubbing (moving) against the side of the tunnel without lubrication.
If you're using a hard plastic flange — apply lubrication on your nipple as a barrier between the nipple and the tunnel so there's no friction. An edible oil like coconut oil or olive oil is ideal. Coconut oil is also antibacterial which can help keep the blister(s) from getting infected. Both coconut oil and olive oil are available at most grocery stores.
If you're using our silicone flanges — see Lubrication in our Silicone Flanges and Lubrication Sources for a checklist of sneaky lubrication sources.
Vacuum blisters are caused by vacuum being so high that the top layer of skin on the end of the nipple separates from the lower level. Turning down the vacuum a bit is usually all that's needed to keep it from happening again.
It's not usually necessary to have the vacuum at a really high setting because pumping is not about sucking milk out of your breast (neither is breastfeeding directly). It's about stimulating your own letdown (milk ejection) reflex to squeeze the milk through your ducts. Reach out to our inhouse LCs if you're having trouble getting enough milk without high vacuum.
When the blisters are white, it's from the top layer of skin being pulled or rubbed so much that it separated from the layer below it and milk was trapped underneath. Treating them is the same whether there's milk inside or not.
Healing Nipple Blisters
To help your blisters heal, tap (don't rub) a *tiny* amount of 1% hydrocortisone cream on the blisters after every nursing or pumping (no need to wash it off, safe for the baby because it absorbs completely). This helps thin the skin slowly so it will break open on its own without introducing bacteria and also helps it heal more quickly.
Gel packs can be very soothing without adding lubrication.
Watch for Infection
Keep an eye on the blister(s) for infection. To help prevent infection, wash your nipples twice a day with mild soap (not antibacterial) and warm water (over the kitchen sink with a sprayer or cup to rinse works well). This breaks the bacterial biofilm to reduce the bacteria's ability to reproduce.
White or yellow discharge or crusting (not inside blisters), especially with pain, are signs that an infection has set in (milk does NOT dry on nipples). See Nipple Infections
Reviewed by Jenn Foster, IBCLC
January 25, 2022