Introduction

Breastfeeding is often described as one of the most rewarding parts of motherhood, but it can also be physically challenging. Most new mothers find the early weeks uncomfortable, particularly if their baby has frequent and intense trouble latching or feeding. The most common issues include nipple fissures, painful cracks, or sores on the nipple.^1,3 These seemingly small injuries can rapidly transform into bacterial culprits of cellulitis or even a more destructive breast abscess. Learning what all of these conditions or warning signs look like, how to identify early warning signs, and how to react fast can ensure your health and that you can continue to breastfeed

What are nipple fissures?

Nipple fissures are small cracks or open wounds that develop on the nipple's surface. They can be caused by a poor latch, incorrect breastfeeding position, or extended breastfeeding sessions.¹ Even with a good latch, some women still develop fissures, especially early in the postpartum period, when the skin is especially sensitive.

Common symptoms

• Visible cuts or scabs on the nipple
• Sharp or burning pain while nursing
• Nipple tenderness between feeds
• Bleeding or spotting on the bra or breast pad
• Dry, flaky skin around the areola

Many new mothers tend to ignore these symptoms as “normal soreness.” Treatment and evaluation for infection are needed for fissures that last more than a few days or seem to worsen.

Why do bacterial infections happen?

The skin around your nipple is a barrier to keep germs away from your body. When that barrier is broken, as with a fissure, bacteria can get inside.^1,2 The most common bacteria that cause the disease are Staphylococcus aureus and Streptococcus, which normally live in the baby's skin and mouth. When these bugs infiltrate a crack, they might trigger a localised infection.

This infection can start as mastitis, inflammation of the breast, and can become more dangerous:

• Cellulitis – a deep skin infection
• Abscess – a pus-filled lump that may require drainage

What is cellulitis of the breast?

Cellulitis is a bacterial skin infection that affects the deeper layers of the skin and underlying soft tissue.^2,3,4 In breastfeeding women, it usually begins near the nipple and spreads to the surrounding breast tissue when it develops.

Symptoms of cellulitis

• Swelling in part of the breast
• Redness that spreads or forms a patch
• Skin that feels hot to the touch
• Deep, throbbing pain
• Fever, chills, or body aches
• Feeling unusually tired or unwell

Case example

A week after delivery, Rachel, a first-time mum, noticed pain and redness around her right nipple. She had dismissed the crack as 'normal' but later developed a fever and red streaking on her breast. Her doctor diagnosed cellulitis and started antibiotics immediately. Within 48 hours, the symptoms improved dramatically.

What is a breast abscess?

If cellulitis is not treated or does not improve with antibiotics, it can evolve into an abscess.³ This is a localised pocket of pus caused by the immune system trying to contain the infection.

Symptoms of a breast abscess

• A painful, firm lump that doesn’t go away
• Swollen, red skin over the lump
• Fever that does not improve with rest or fluids
• Thick, yellow, or green pus draining from the nipple
• Reduced milk flow or refusal by the baby to feed from that breast

Unlike cellulitis, abscesses often require drainage, as antibiotics alone may not be enough.

When should you worry?

Nipple fissures are common and often minor, but there are times when you need to get medical help right away.^1,2 These red flags mean the infection may be getting worse:

• Fever over 100.4°F (38°C)
• Shaking chills
• A red, painful, or hard area that is not improving
• A warm, tender lump that feels like a boil
• Discharge or pus from the nipple or skin
• Ongoing pain during and between feeds

Even if you are unsure, it is always best to check with your healthcare provider.

How are these conditions diagnosed?

Your doctor or nurse practitioner will ask you about your symptoms, regular diet, breastfeeding routine, and any pain or changes in your breasts.^3,4 They will do a physical exam, looking for redness, swelling, lumps, or discharge.

If there is suspicion of an abscess, they may send you for a breast ultrasound. This painless imaging test uses sound waves to see inside the breast and detect any fluid collections.

Sometimes, your provider might collect a breast milk or fluid sample for lab testing to see which specific bacteria are behind the problem and which antibiotics will work best.

What treatments are available?

For nipple fissures (No infection)

• Breast milk therapy – Applying your milk to the nipple promotes healing
• Lanolin cream – Roothes and protects the skin
• Warm compresses – Reduce pain and inflammation
• Air-drying – Avoid moisture buildup by allowing the nipples to dry after feeds
• Nipple shields – Temporary silicone covers that reduce friction

Most fissures improve within a few days with proper nipple care and breastfeeding adjustments. Most fissures improve within a few days with good nipple care and breastfeeding modifications.

For cellulitis

• Antibiotics – Normally used ones include Dicloxacillin, Cephalexin, or Clindamycin.
• Pain relief – Ibuprofen or acetaminophen can reduce pain and swelling
• Breastfeeding support – Keep nursing or pumping to avoid milk buildup
• Hydration and rest – Significant to help your body fight infection

You should see improvement within 24–48 hours of starting antibiotics. If not, a follow-up visit is important.

For breast abscess

• Ultrasound-guided needle drainage – a needle is used to draw out pus
• Incision and drainage (I&D) – a minor surgical procedure for larger abscesses
• Antibiotics – continued during and after drainage
• Breastfeeding guidance – feeding may resume from the affected breast if safe

Abscesses typically heal well with proper treatment, but may take longer to resolve fully.

Can I continue breastfeeding?

Yes, in most cases, it is safe and advisable to continue breastfeeding while undergoing treatment.^1,2 Stopping breastfeeding can cause milk stasis, worsening inflammation, and slowing of healing. However, if the infection involves the nipple or an open abscess with pus, you may have to stop feeding through that breast to feed through the other breast or pump and discard milk from the affected breast.⁴

Note:

Always consult your provider to ensure breastfeeding is safe in your case.

Preventing infections and nipple damage

While not all infections are preventable, you can greatly reduce your risk with good nipple care and breastfeeding support:

1. Proper Latch – Work with a lactation consultant to ensure your baby latches correctly and does not bite or pull
2. Nipple Care – After each feed, rinse with water and apply expressed milk or lanolin
3. Avoid Harsh Products – Do not use strong soaps or alcohol-based wipes on nipples
4. Air Exposure – Let nipples dry between feeds to prevent yeast or bacterial overgrowth
5. Manage Engorgement – Regular feeding or pumping helps avoid blocked ducts
6. Act Early – Seek care quickly if pain, redness, or fissures develop

FAQs

How can I distinguish between normal nipple soreness and an infection?

Normal soreness improves as the feeding technique improves and usually does not involve fever or swelling. Infection worsens pain, redness, fever, or a tender lump.

Will antibiotics affect my baby if I’m breastfeeding?

Most antibiotics prescribed for breast infections are safe during breastfeeding. Always tell your provider that you are nursing so they can prescribe the right one.

My baby won’t nurse on the sore side—what do I do?

Change positions and pump to keep the breast drained. Depending on your doctor's advice, you can freeze or discard the milk.

Can I treat a nipple fissure at home?

Yes, in many cases. Clean the area, use breast milk or lanolin cream, and correct your baby’s latch. See your provider if it doesn’t heal within a few days.

What if the abscess comes back after drainage?

Recurrent abscesses may signal that the infection was not fully rid or that an ongoing cause, such as poor drainage, is present. Further imaging, longer antibiotics, or even surgical treatment may be necessary.

Summary

Nipple fissures are a common issue for breastfeeding mothers, particularly in the early postpartum period. Most fissures heal independently, but sometimes they can allow bacteria to get into the skin, causing an infection, such as cellulitis or a breast abscess. Warning signs include breast pain, swelling, redness, warmth, fever, or pus. It is important to seek medical care if these symptoms develop. The treatment usually consists of antibiotics and good breast hygiene, in some cases accompanied by drainage of an abscess. People with most breastfeeding infections respond well to early intervention. Breastfeeding is generally safe and often beneficial during treatment. With prompt care and support, most mothers fully recover and breastfeed without further problems.