Nipple blanching and vasospasm • KellyMom.com (2022)

By Kelly Bonyata, BS, IBCLC

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush. If the normal color returns after your baby has finished a feeding and there is no pain, then the blanching is not a problem.

Blanching due to compression

The most common reason for nipple blanching is that that baby is compressing the nipple while nursing. This can be due to:

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  • a shallow latch (the most common problem)
  • improper sucking
  • baby clamping down to slow a too-fast let-down
  • tongue-tie
  • baby clamping due to allergies
  • clampdown bite reflex
  • palate variations, etc.

When blanching is due to baby’s compression of the nipple, the nipple is white and often misformed (flattened, creased, pointed, etc.) immediately upon coming out of baby’s mouth. There may be a white stripe across the nipple directly after nursing. Pain may not start until a few seconds to a few minutes after nursing, as the circulation returns to the nipple. If you are experiencing pain with the blanching, then finding and remedying the underlying cause will also eliminate the blanching.

Blanching due to vasospasm

Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings. Vasospasm can have various causes:

(Video) Sore Nipples, Part 3 | Isis Parenting

Vasospasm can be a secondary response to pain or nipple trauma (damaged nipples or thrush). In this case, the nipple(s) turns white shortly after nursing (rather than coming out of baby’s mouth white and misformed). Mom might notice a white circle on the face of the nipple a few seconds to a few minutes after breastfeeding. Cold often triggers the vasospasm and/or makes it worse. Unlike blanching due to compression, latch and positioning may be fine if the source of any nipple damage has already been fixed. Healing the nipple trauma or other source of pain should eliminate the vasospasms, although they may persist for a short time after the nipple has healed (previously damaged tissue can remain sensitive for a time).

Raynaud’s of the nipple

Nipple blanching and vasospasm • KellyMom.com (1)

White and red phases of vasospasm from Raynauld’s. Image used with permission.

Vasospasm can also be caused by Raynaud’s Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud’s Phenomenon (Raynaud’s of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change – from white to blue to red – as blood flow returns. The color change may also be biphasic – from white to blue.

Vasospasm due to Raynaud’s is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud’s phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.

Per Anderson et al, “Because the breast pain associated with Raynaud’s phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud’s phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents.”

Keep in mind that Raynaud’s is not caused by breastfeeding (anyone might have it) — it simply has the potential to affect breastfeeding. For example, any person might have inverted nipples, which might or might not affect a mother’s breastfeeding relationship (as this can make latching or sore nipples more of a challenge in the beginning). Raynaud’s works the same way – anyone might have it coming into breastfeeding, and it might (or might not) affect the breastfeeding relationship if the vasospasms are triggered by bad latch, a sudden temperature change as baby unlatches, etc.

Some maternal medications have been associated with vasospasm, including oral contraceptives containing estrogen. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud’s phenomenon. Some sources indicate that the antifungal medication fluconazole may be associated with vasospasm, although the manufacturer does not report this as a known complication of fluconazole use. Other sources feel that vasospasms experienced by mothers taking fluconazole are a result of nipple pain/trauma due to thrush (and not due to the medication used to treat the thrush).

Treatment options for vasospasm

  • Avoid cold. Apply dry heat to the breast when needed (this relaxes the “cramping” blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.)
  • Cover the nipple as soon as possible after baby comes off the breast. Some moms say that it is helpful use a wool breast pad or a soft cloth diaper.
  • Apply dry heat immediately after breastfeeding. A rice sock can be useful as a source of dry heat: Fill a sock or a cloth bag with uncooked rice and microwave 45 seconds (or until desired warmth is achieved); hold the rice sock against the nipple (over the cloth or mom’s shirt) until blood flow resumes.
  • Massage the nipple with olive oil when mom is feeling pain from the vasospasm.
  • Avoid caffeine, nicotine/smoking, diet pills, cold medications containing pseudoephedrine or phenylephrine, beta blockers, and other vasoconstrictive drugs, as they can precipitate symptoms. Oral contraceptives containing estrogen have also been associated with vasospasm.
  • Medications and dietary supplements may also be helpful:
    • Ibuprofen.
    • Dietary supplementation with calcium/magnesium.
    • Dietary supplementation with a vitamin B complex that includes B6 and niacin.
    • Dietary supplementation with fish oil supplements.
    • Low dose oral nifedipine.

See links below for additional details.

Additional information and references

Nipple pain – links @ Nipple blanching and vasospasm • KellyMom.com (2)

Vasospasm and Raynaud’s Phenomenon by Jack Newman, MD

Nipple Vasospasm and Breastfeeding byPhilippa Pearson-Glaze IBCLC

Patient information: Raynaud phenomenon (Beyond the Basics)by Fredrick M Wigley, MD

Clampdown Bite Reflex by Mary Jozwiak, from Leaven, Vol. 30 No. 4, July-August 1994, pp. 53-4.

References

Anderson JE, Held N, Wright K. Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. Pediatrics. 2004 Apr;113(4):e360-4.

Garrison CP. Nipple vasospasms, Raynaud’s syndrome, and nifedipine (case report). J Hum Lact. 2002 Nov;18(4):382-5.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett 1999, p. 492-493.

Lawlor-Smith L, Lawlor-Smith C. Raynaud’s phenomenon of the nipple: a preventable cause of breastfeeding failure? Med J Aust. 1997 Apr 21;166(8):448.

Lawlor-Smith L, Lawlor-Smith C. Vasospasm of the nipple – a manifestation of Raynaud’s phenomenon: case reports. BMJ. 1997 Mar 1;314(7081):644-5.

Snyder JB. [letter]. J Hum Lact. 1994 Sept;10(3):153.

Escott R. Vasospasm of the nipple: another case [letter]. J Hum Lact. 1994 Mar;10(1):6.

Coates MM. Nipple pain related to vasospasm in the nipple? J Hum Lact. 1992 Sep;8(3):153.

An Overview of Solutions to Breastfeeding and Sucking Problems by Susan Meintz Maher, IBCLC, La Leche League 1988, p 14.

FAQs

Why are my nipples blanched? ›

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain.

How do I know if I have nipple vasospasm? ›

Women with vasospasm commonly describe it as an intense, throbbing, burning type of pain in their nipples. When the blood vessels in the nipples are affected by vasospasm, pain can be felt before, during or after breastfeeds. The pain can last for a few seconds or longer.

What does nipple vasospasm look like? ›

Describing nipple vasospasm

Some women describe the pain as a burning and throbbing. You may notice the nipple or the tip of the nipple blanches or turns white. You may notice other colour changes of the nipple. The nipples may turn blue or purple or red before returning to their normal colour.

Does nipple blanching go away? ›

Once sore nipples heal, blanching will often stop. Make sure your baby is latching on properly. If you aren't sure your baby is breastfeeding correctly, call your doctor, a lactation consultant, or a local breastfeeding group for assistance.

Why are my nipples turning white while pregnant? ›

White spots on the nipples and the surrounding area during pregnancy may be caused by normal hormone changes, blocked pores and ducts or infections. During pregnancy, a change in the size and number of Montgomery glands is the most common reason to see white spots on the breast.

Why is my areola turning pale? ›

After menopause, your nipple area may become smaller and paler. This is perfectly normal and one of the many common changes that can affect your breasts over time. Changing hormone levels. Your hormones can have a lot to do with the darkening or lightening of your nipples and areolae.

How do you fix nipple vasospasm? ›

Nipple vasospasm may be effectively treated by applying warmth and nifedipine, and there are lay reports of calcium, magnesium, and fish oil supplements being helpful.

Will nipple vasospasm go away? ›

Vasospasm tends to last for longer periods of time than nipple blanching and does not go away even with good attachment at the breast during feeds. Cold is usually the trigger for vasospasm. This happens when your baby stops breastfeeding and pulls off the breast exposing your nipple to the cooler air.

Why do my nipples turn white when I pump? ›

Has your nipple looked waxy or dull white after feeding or pumping? That's because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area.

What do blanched nipples look like? ›

With blanching, you might notice the following: A white or misshapen nipple as soon as it leaves your baby's mouth. A white stripe across your nipple. Some pain a few minutes later as circulation and blood flow returns.

How do you treat Raynaud's nipples? ›

Nondrug treatments include optimizing breastfeeding technique, warming the nipples, stress management, and avoiding the cold. Avoidance of caffeine, nonselective beta-blockers, and vasoconstrictors (e.g., pseudoephedrine) is also recommended.

Why do my nipples feel like they are on fire after breastfeeding? ›

Nipple vasospasm is a narrowing of blood vessels in the nipple. It can be triggered by a baby breastfeeding in a shallow latch and can cause burning, stabbing or itching pain in the nipples after a breastfeed.

Why do my nipples turn white when cold? ›

My nipples turned white and felt like they were going to freeze off. What's happening? You could be experiencing something known as “Raynaud's Phenomenon.” When you get cold and/or stressed, small arteries constrict (aka vasospasm), causing intense pain and a temporary loss of pigment.

Can pumping cause vasospasm? ›

In exclusive pumping mothers, vasospasms frequently occur after pumping sessions, when the air hits the nipple after the flanges are removed. It's common to feel a burning pain, followed by a color change in the nipple.

Can you have Raynaud's in your nipples? ›

Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding.

What does it mean when your nipples lose color? ›

Nipples color can temporarily change due to things like normal hormonal shifts, pregnancy, or breastfeeding. The same goes for nipple size and texture. Permanent changes of the nipple can also occur and are often seen with breast surgeries, weight loss, and aging.

Why are the tips of my nipples white and sore not breastfeeding? ›

White spots on your nipples may look unusual, but they usually aren't cause for concern. Oftentimes, they're caused by a blocked pore (bleb), a harmless condition caused by a backup of dried milk in your nipple.

Does white spots on nipples mean I'm pregnant? ›

Montgomery's tubercles around your nipples may be one of the first symptoms of pregnancy. They may be noticeable even before you've missed your period. Not every woman who experiences Montgomery's tubercles is pregnant. If you notice these bumps and have other pregnancy symptoms, you should take a home pregnancy test.

Can areolas get lighter during pregnancy? ›

Size, Color, and Shape

The shape of the areola can be round or oval, and the color can be any shade of red, pink, or brown. After breastfeeding has ended, the areola may return to a lighter shade, but it typically remains a darker color than it was before pregnancy.

How quickly does Paget's disease of the breast progress? ›

The skin lesions progress slowly over months as scaly, fissured, or oozing erythema of the nipple and areola. Advanced lesions may appear as well-demarcated, eczema-like plaques with a pink or red hue. Although uncommon, the surface may appear slightly infiltrated and erosive, oozing, scaly or crusted [2].

Is it normal for areolas to change Colour? ›

Nipples naturally change in color over time and due to many different biological events during a person's life. The color change is nothing to worry about, and the nipples will usually lighten again after the normal body changes have occurred.

What does it mean when your nipples lose color? ›

Nipples color can temporarily change due to things like normal hormonal shifts, pregnancy, or breastfeeding. The same goes for nipple size and texture. Permanent changes of the nipple can also occur and are often seen with breast surgeries, weight loss, and aging.

Why are the tips of my nipples white and sore not breastfeeding? ›

White spots on your nipples may look unusual, but they usually aren't cause for concern. Oftentimes, they're caused by a blocked pore (bleb), a harmless condition caused by a backup of dried milk in your nipple.

How do you treat Raynaud's nipples? ›

Nondrug treatments include optimizing breastfeeding technique, warming the nipples, stress management, and avoiding the cold. Avoidance of caffeine, nonselective beta-blockers, and vasoconstrictors (e.g., pseudoephedrine) is also recommended.

Why do my nipples turn white when cold? ›

What is Vasospasm? A condition known as Raynaud's phenomenon, where your fingers turn white when they are cold can also affect the nipples. Pain can occur during, immediately after, or even between breastfeeds. You may notice that your nipple turns white.

Are your lips the same color as your nipples? ›

According to a segment on "The Doctors," the best way to find your perfect natural lipstick shade is to go with the color of your nipple. Your top lip is apparently the exact same shade as your nipple.

How quickly does Paget's disease of the breast progress? ›

The skin lesions progress slowly over months as scaly, fissured, or oozing erythema of the nipple and areola. Advanced lesions may appear as well-demarcated, eczema-like plaques with a pink or red hue. Although uncommon, the surface may appear slightly infiltrated and erosive, oozing, scaly or crusted [2].

How long does vasospasm in breast last? ›

Nipples may change colour (red, white, or purple) and go back and forth between colours (e.g. white to pink, back to white) for several minutes or even an hour or two.

Can pumping cause vasospasm? ›

In exclusive pumping mothers, vasospasms frequently occur after pumping sessions, when the air hits the nipple after the flanges are removed. It's common to feel a burning pain, followed by a color change in the nipple.

Why do my nipples feel like they are on fire after breastfeeding? ›

Nipple vasospasm is a narrowing of blood vessels in the nipple. It can be triggered by a baby breastfeeding in a shallow latch and can cause burning, stabbing or itching pain in the nipples after a breastfeed.

Can you have Raynaud's in just your nipples? ›

Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding.

What does vasospasm feel like? ›

When a vasospasm develops in the coronary artery, the main symptom is chest pain often described as constricting, crushing, pressure, squeezing or tightness. Patients who have experienced hemorrhagic stroke are at an increased risk of developing a cerebral vasospasm.

Can you get Raynaud's in your nipples? ›

Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding.

Why do my nipples turn white when I pump? ›

Has your nipple looked waxy or dull white after feeding or pumping? That's because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area.

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