Inverted nipples do not protrude from the level of the areola but are retracted inwards instead (see image below right of an inverted nipple compared with a normal nipple). Some severely-inverted nipples are fully stuck inwards while others can be drawn out with suction, such as with a breast pump or syringe. Flat nipples are level with the areola.
Inverted nipple compared with normal nippleNipple preparation (including for mothers with inverted or flat nipples) is unnecessary. All nipples tend to become more supple during pregnancy, so there is no need to be too concerned before pregnancy or in the early stages.
For mothers with inverted or flat nipples, the baby is more likely to attach and feed well if he becomes used to breastfeeding from very early on. It is best to avoid bottles and teats at this time, as these are very different in shape to the inverted or flat nipple. If supplements are medically required, a cup or syringe may be better choices. If possible, avoid medications during labour so the baby can be fully alert, with all inborn reflexes intact, for the first feeds. During the first few days (before the milk comes in) breasts are soft and the baby’s sucking action is strong. It is worth noting that babies do not nipple feed but breastfeed. Referring to the Breastfeeding plan article on this website can help get breastfeeding off to the best start possible.
Once the breasts become full or engorged, the baby may find it harder to attach. A little hand expressing or reverse pressure softening can help to soften the area around the nipple making it easier for the baby to attach.
A mother may be able to draw her nipple out before feeds either manually or with a breast pump. She is likely to know whether touch or applying a cold compress will also help the nipple to stand out more.
If a baby continues to have ongoing problems with attachment once a mother’s milk has come in, a nipple shield may be helpful.
Rest assured, that many mothers who have difficulties breastfeeding due to anatomical challenges first time around, often find that second or third time around that things are easier.
How do I know if my nipples are flat or inverted? It’s as easy as one-two-squeeze. Simply place your fingers on the edge of the areola (the dark area surround the nipple) and compress it (lightly, please).
If the nipple protrudes forward, you’ve got nothing to worry about. If, on the other hand, your nipple retracts inward, you’ve got inverted nipples.
While most nipples bump out — even in a resting position — flat nipples are, you guessed it, flat. If you’re not sure, your practitioner can do a quick exam and let you know the status.
The good news is that the outward appearance of nipples in no way affects the production of breast milk or your ability to dispense it.
What can I do about my flat or inverted nipples? Many practitioners say you don’t need to do anything ahead of time since most flat and inverted nipples perform their job as well as any other nipples once breastfeeding begins.
But some women do need a little help to get the job done. To the rescue: breast shells. These plastic wonders (available in most baby stores or through your lactation consultant) are worn over your nipples and apply painless pressure to gently and gradually draw them out.
You can start using them before your baby is born but it’s really not necessary — wearing them between feedings should be enough to draw the nipple out to an easily suckled position.
Do be aware that breast shells might cause sweating and rashes and can be pretty conspicuous (particularly if you’re wearing a thin shirt).
Another option is drawing out your nipples with a breast pump immediately before nursing (though don’t pump more than a few times or else milk will start flowing — and not into baby’s mouth where it belongs!).
One more word of caution: Plastic devices (shields) designed to be worn during feedings to draw out the nipple are not recommended by lactation specialists because they can prevent your baby from grasping onto the nipple properly, setting up a longer-term problem of inadequate milk supply and demand.
The potential problem
Flat nipples don’t stand out much from the surrounding area (called the areola) and don’t protrude when stimulated. That sometimes can make it difficult for your baby to latch on and breastfeed.
Inverted nipples retract or pull inward when stimulated. They may look flat, or their appearance may range from slightly dimpled and indented to very clearly indented in the center.
Check your own nipples by gently squeezing the areola about one inch behind the nipple with your thumb and index finger. If the nipple becomes dimpled or clearly indents, it’s inverted.
Can I breastfeed?
In most cases, yes. Changes in your breasts during pregnancy may make your nipples protrude more than usual. On the other hand, inverted nipples can pull in even more when your breasts become engorged. (In extremely rare cases, deeply inverted nipples can sometimes obstruct milk flow.)
The best way to find out whether you can breastfeed is to go ahead and try.
Flat nipples shouldn’t pose a problem unless your baby isn’t latching on well or your breasts are overly full or engorged.
Seek guidance from a lactation consultant. She may suggest that you briefly use a breast pump to draw out the nipple before nursing and pull back on the breast tissue while your baby is latching on to help the nipple protrude.
She may also recommend a technique known as “reverse pressure softening.”
If your nipples are protruding less because your breast tissue is swollen with IV fluid after delivery, then your nipples will return to normal as the fluid leaves your body.
In this case, you may have to pump your breast milk for a week or so until your nipples protrude enough to nurse.