Not all nipples are the same! Most people think of a nipple as a small knob at the end of a breast. It is darker than most of the breast tissue, is firmer and more textured, and sits in the middle of a darker patch of breast skin called the areola. The average size of the nipple part of the breast is 1.3cm across and sticks out about .9cm. That’s about the size of a ladybug. That’s not very much to grab, but a baby actually needs to grab more than just the nipple for breastfeeding. To get the most milk for the baby and the most comfortable latch for you, a baby actually needs to put the nipple AND most of the areola into the mouth.

Getting a lot of breast tissue into the mouth is one of the keys to a good latch and breastfeeding success, and for that reason, having flat or inverted nipples might not be a barrier to great breastfeeding.

What are Flat or Inverted Nipples?

A flat nipple is one that just doesn’t stick out much or at all. An inverted nipple is one that folds in on itself or appears to point in instead of out. You might actually be able to create an inverted nipple if you don’t naturally have one. You can poke the nipple in so it looks like it’s gone or inside-out. But then it pops right back out. An inverted nipple is like that all the time. It doesn’t pop back out. There are different kinds of inverted nipples:

• Retracted: This nipple looks like it could be grabbed, but when it’s touched it goes in! Trying to pinch it or grab it doesn’t work.
• Pseudo-inverted: This nipple looks like it’s inside out, but it pops out when stimulated.
• Dimpled: This nipple looks like part of it tucks or folds in. It may extend for breastfeeding, but afterwards will fold back in. It’s important to pat the nipple dry after feeding your baby or pumping if this is the case for you. That can help avoid too much dampness and soreness inside after feedings.
• Complete inversion: This nipple stays inside out before and after stimulation.

Fortunately, the nipple is not the most important part of your anatomy for breastfeeding. Even if you have an inverted nipple, you still have milk ducts on the inside which make and hold the milk, you still have the little tubes which carry the milk to the surface, and you still have openings on the breast for the milk to come out of. It might be more challenging to give the baby something to hold onto easily, but it can often work just fine and without too much struggle.

Sometimes flat and inverted nipples fix themselves during pregnancy and after birth. Sometimes, if a baby can latch and feed regularly, it helps correct the issue and the nipples can continue to get a little bigger after each pregnancy and baby.

So, if you have flat or inverted nipples, there is still a good chance that breastfeeding can progress normally!

How to Breastfeed with Flat or Inverted Nipples

Here are some things that might help:

• If you have pain medication during labor or after, some can get into your bloodstream and then to your baby. Some medications can cause sedation. These babies might be more tired and weak until the medication wears off. If you’re considering an unmedicated birth AND have flat or inverted nipples, this might be something to keep in mind for your decision making. Giving the babies the best chance to get a good latch and a good feed from the beginning is a great way to start breastfeeding.
• Making sure you have immediate skin-to-skin contact after birth is another way to increase the chances of success at that first feed.
• Allowing a just-born baby to self-attach to the breast has been shown to increase success. This is sometimes called baby-led latching. Babies are born with instincts to find the breast, and when you can allow them to go through the natural progression of behaviors, they often do a better job of breastfeeding for the first time. Especially when you have flat or inverted nipples, these little boosts might help things go more easily.
• Keeping your nipple area soft is helpful. When the more mature milk starts to be produced (usually on day 3-5), the breasts can get very full or “engorged”.
• When this happens, it can be even harder to hold on to a nipple and get plenty of breast tissue into the baby’s mouth. Softening the breasts will be extra helpful in this situation. This Easing Engorgement How-To Guide can give you some ideas for managing engorgement.
• It’s a good idea to avoid artificial nipples, at least until your baby is very comfortable breastfeeding. An artificial nipple on a bottle is much easier to grab and get milk from, so your baby may be more likely to reject your nipple after using an artificial nipple.
• In some cases you can stimulate the nipple to protrude with some stimulation. You can try gently pulling on it or rolling the nipple between your finger tips.
• You can apply ice or cold stimulation. You can also just let your baby do what they naturally do. A baby will often stimulate a breast before feeding by licking, grabbing, and pulling. If you have an adventurous partner, you might ask them to help get it started for you using suction. This really can work sometimes!
• Pulling back on the skin just before the baby latches on can sometimes expose a little more of the nipple.
• You can push up on the nipple from the underside. Using your finger, you would press down on the areola next to the nipple area trying to get “under” the nipple to push it up and out.
• You may help your baby get latched on by shaping or flattening the breast tissue for them. If you can compress the breast tissue sort of like you would a sandwich that is too tall to bite, it might help the baby get a good mouthful.
• Using a nipple shield may be helpful, especially if nothing else has worked. It’s important to get the right fit and use it correctly for best results.
• Other devices like a pump or a commercial suction device might be helpful to draw the nipple out. You might use it right before a feed to get the baby latched on, or sometimes people will use the tool regularly in the hopes that it will correct the flat or inverted nipple more permanently. There is no guarantee that this will work, but if all else fails, it might be a good option to try. Just be careful not to do too much. You can cause cracks or blisters with too much suction.

If you have flat or inverted nipples and you’re worried about being able to breastfeed your baby, it’s great to see a lactation consultant for an assessment and to talk about what you might be able to do to prepare. They should also be able to help you figure out the techniques that work best for your body and your baby.

Resources

https://breastfeeding.support/breastfeeding-inverted-nipples-flat-nipples/
https://www.magicalhour.org/aboutus.html
https://breastfeedingusa.org/baby-led-latch-how-to-awaken-your-babys-breastfeeding-instincts/