Nipple fissures from breastfeeding: how can they be removed?

A breastfeeding fissure is characterised by a wound on the nipple, resembling a crack or a small scab. It can be more or less red and more or less deep, depending on its stage of progression. It's worth noting that a breastfeeding fissure is not always visible, especially when it has just formed. The woman then notices its presence due to the pain she feels during breastfeeding. It happens that the fissure bleeds and forms a scab that can become infected if not properly managed.

The most common cause of the appearance of breastfeeding fissures is a poor positioning of the baby during feeding. This occurs when the baby does not latch onto the breast properly and only suckles the nipple superficially. It's as if the baby is crushing the nipple between their tongue and palate, which is abrasive for the mother. Over time and with repeated breastfeeding, a small lesion forms, becoming increasingly painful and deep. The friction can also result from a poor adjustment of the size of the breast shield or incorrect placement of a silicone nipple shield.

It also happens that breastfeeding fissures are the result of a tongue tie in the baby. Also known as ankyloglossia, this congenital anomaly is defined as a tongue tie that is too short and/or too fibrous, thus lacking elasticity. The tip of the tongue then struggles to extend beyond the lips, which causes difficulties during breastfeeding. A minor surgical procedure is then necessary.

The most effective way to prevent breastfeeding fissures is to pay close attention to the position of the baby during feeding. The baby should lean more on their chin rather than their nose to avoid causing friction. Furthermore, it is recommended to ensure that the baby's mouth is wide open to accommodate a large part of the areola.

You can also use a breast pump at the beginning of the feed to stimulate the ejection of milk from the breast. This will gradually stretch the nipple into a "correct" shape to present to the baby. Indeed, this will increase the chances of the baby properly latching onto the entire areola, thus avoiding the occurrence of cracks.

Another tip involves the use of breastfeeding shells. These serve to protect the nipple from additional friction and irritation caused by underwear. They are also useful for collecting excess breast milk that is ejected, preventing it from staining clothes. Lastly, breastfeeding shells promote the healing of breastfeeding fissures, according to the so-called "wet healing" method. The shells help to maintain the breast in the moist environment of the breast milk, which possesses healing properties. These properties are derived from the SPMs (Specialized Pro-resolving Mediators) it contains, molecules capable of reducing inflammatory reactions and stimulating the immune system.

The healing of breastfeeding fissures can be a lengthy and painful process. During this time, it is theoretically still possible to breastfeed, but it is painful. There are several methods available to promote healing.

• Breast Milk : Rich in anti-inflammatory substances and containing anti-infective agents, breast milk aids in healing in the event of fissures. It is sufficient to apply a few drops on the nipple after each feeding.

• Lanolin : also known as wool fat, this natural substance poses no risk if ingested by a baby. It has soothing and emollient properties, and is often presented in the form of a cream, ointment or salve. Simply apply a dab to injured nipples before and after each feeding.

• Breastfeeding shells : as previously explained, breastfeeding shells promote healing by trapping the remaining milk at the breast level and taking advantage of its healing properties. Moreover, they protect the nipples from the friction caused by bras.

• Hydrogel dressings : available over-the-counter in stores and pharmacies, these special dressings help to alleviate burns and soothe the pain caused by fissures. They are to be applied to the nipples between each feeding.

• KRONBORG H. & al. Early breastfeeding problems: A mixed method study of mothers' experiences. Sexual and Reproductive Healthcare (2018).