Puffy Nipples: 6 Common Causes (& What to Do)

Puffy nipples can be noted with hormonal fluctuations, which can occur during pregnancy, breastfeeding or a period. In these cases, puffiness is not a cause for concern, as it is a symptom that eventually resolves on its own.

However, in some cases, like in people with a nipple piercing, for example, puffy nipples can present with other symptoms, like pain, hardening or discharge.

Puffy nipples that present with other, more intense symptoms should be assessed by a doctor for treatment as necessary.

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Why are my nipples puffy? 

The main causes of puffy nipples are:

1. Contact dermatitis

Puffy nipples can result from a condition called contact dermatitis. This skin conditions is characterized by an exaggerated skin reaction to a certain substance or object, and leads to symptoms such as redness, itching, swelling and peeling.

What to do: Avoid further contact with the irritating substance and rinse the nipple with plenty of cold water. In some cases, the doctor may also prescribe a corticosteroid cream or an antihistamine until symptoms improve. 

2. Mastitis 

Mastitis is characterized by inflammation of the breast and causes symptoms such as pain, swelling or redness. This inflammation can develop into an infection and cause fever and chills.

Mastitis is more common in women who breastfeed, especially during the first three months. In these cases, it occurs due to obstruction of the milk ducts, or the entry of bacteria into the ducts. However, mastitis can also occur in men or at any other stage of a woman's life due to the entry of bacteria into the breast through a nipple injury.

What to do: Mastitis treatment involves rest, increased fluid intake, analgesics and anti-inflammatories. Infections can be additionally treated with antibiotics.

3. Friction

The nipple can also become puffy and irritated due to simple factors like friction caused during breastfeeding, physical or sexual activity.

What to do: To prevent nipple injuries and friction, you can lubricant ointments like petroleum jelly or zinc oxide, before and after exercising and after sexual activity.

For breastfeeding mothers, this problem can be resolved by applying a drop of milk to the nipple after each feeding or a lanolin ointment. If pain during breastfeeding is very severe, the mother can express the milk manually or with a pump and feed it to the baby with a bottle until the nipple improves or completely heals. There are also breastfeeding flanges that can be applied over the nipple to reduce pain during suckling.

4. Mammary duct ectasia

Mammary duct ectasiais characterized by the dilation of a milk duct beneath the nipple. This duct fills with fluid and can become blocked or obstructed and lead to mastitis. Some of the symptoms that may occur include the release of fluid from the nipple, sensitivity to touch, redness, swelling or inversion of the nipple.

What to do: Mammary duct ectasia may not require treatment and can heal on its own. However, if it does not resolve, the doctor may administer antibiotics or even recommend surgery.

5. Menstruation

In the last 12 days of the menstrual cycle, which corresponds to the luteal phase, there is an increase in progesterone and estrogen levels in the blood. This causes symptoms such as nipple and breast sensitivity, mood changes and swelling.

What to do: Since menstruation is a physiological change that is expected, no interventions are necessary. However, in cases with very intense symptoms, you should see a doctor for assessment and treated. The doctor may prescribe analgesics or contraceptives.

6. Piercings

Placing a piercing in one or both nipples can cause inflammation in the area, either due to the body's response to the piercing or due to infection. This can lead to the appearance of symptoms, such as nipple hardening, pain, discharge, increased sensitivity and pain.

What to do: Infected or swollen piercings should be kept clean and dry. The doctor may prescribe anti-inflammatory medications and antibiotics. Read more about the symptoms of an infected piercing and the aftercare required to speed-up recovery.