Are you worried about breastfeeding with flat or inverted nipples?
Just like breasts, our nipples come in all shapes and sizes.
Your nipples are designed to stick outward when touched, stimulated by your hormones, or cold. This shape makes it easy for baby to latch onto your breast and start sucking.
Around 10% of women have a nipple shape which benefits from a few tricks to aid breastfeeding.
This guide is to help inform you about tips and techniques to breastfeeding with flat or inverted nipples. Knowing this advice in pregnancy can prepare you to avoid breastfeeding attachment problems.
Your confidence will skyrocket when you realize that it is possible to breastfeed with flat or inverted nipples.
There is a lot to take in, so I recommend you pin this guide to have it close by. That way you can quickly reference it when you need to.
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Flat and Inverted Nipple Breastfeeding Guide
You can assess your nipples to discover what type of nipples you have. You may already know you have flat or inverted nipples. However, this may change during pregnancy or after birth.
I recommend first doing this in pregnancy. If you find any issues, you can prepare for breastfeeding with correction techniques.
Once your baby is born, reassess your nipples. I recommend doing this again as hormonal changes may cause your nipples to naturally protrude once your baby arrives.
The best way to assess your nipples is the pinch test.
Nipple Pinch Test
The pinch test will give you an idea of how your nipple will respond when your baby sucks during a feed.
- Expose your breast, and place your thumb and forefinger around one inch back from your nipple.
- Make sure one finger is above, and one directly below and gently press together.
- Remember to do this test on both breasts as you may get different results for each one.
When you press down, you should see one of three nipple type: Everted, flat or inverted.
Everted (Normal) Nipples
An everted nipple will look ‘normal’ and sticks out when you do the pinch test. Your nipples are the ideal shape for breastfeeding. When your nipple sticks out it is long and firm enough to reach the roof of your baby’s mouth and stimulate sucking.
You don’t need any nipple treatment to help you breastfeed. I recommend learning the importance of a good breastfeeding latch to prevent pain.
A flat nipple will stay completely flat, even when you do the pinch test. You probably find your nipples never stick out even when they are stimulated, or you are cold.
Flat nipples can be temporary especially soon after birth. The most common reasons for this include:
- Engorgement – When your breast is so full of milk the nipple can’t protrude. Hand expressing off a few drops should soften the breast enough to help baby latch on.
- Swelling – This is common post-delivery especially if you received IV fluids. Gentle breast massage can help encourage the fluid to move from the breasts.
- Short Nipples – Some women simply don’t have long nipples.
You will benefit from techniques in this guide to help draw your nipple outward to breastfeed.
An inverted nipple will pull inwards when you do the pinch test. Rather than sticking out it will look like a dimple in the middle of your areola. There are three grades of an inverted nipple:
- Grade 1 – Mild inversion. Usually won’t cause issues with breastfeeding.
- Grade 2 – Moderate inversion. Manageable with a healthy term baby, may cause issues with preemies or if your baby has a poor suck.
- Grade 3 – Severe inversion. Will require lots of help an input with breastfeeding. Your doctor may suggest surgery to reverse the inversion.
It’s thought inverted nipples can be caused by variations in the breast anatomy including:
- Internal adhesions on the breast tissue
- Short lactiferous sinuses
- Thinner connective tissue
All of these cause the breast to pull inwards, or lack support to push it outwards.
It may be you whole nipple or only part that is inverted. Any type of nipple inversion will benefit from the techniques in this guide to assist breastfeeding.
Flat and Inverted Nipple Treatment
There are lots of different techniques you can use to try and draw to nipple outwards before a feed. These tricks haven’t been studied for how truly effective they are. However, women have been using them for years with success. You may find one that works well for you or a combination of techniques.
This technique was invented in the 1950s to help draw out the nipple.
- Place a thumb on each side of your nipple. Start at the base of the nipple not the edge of the areola.
- Firmly your thumbs firmly into the areola.
- While pressing down, pull your thumbs in opposite direction from each other.
- Repeat for 5 pulls
- Move your thumbs into a different position on the nipple and repeat. Think of your breast as a clock and try to pull in as many different directions as possible.
In pregnancy, you should aim to do this technique around 5 times a day. I only recommend starting after 37 weeks, as nipple stimulation can cause contractions.
Once your baby is born its best to do it just before each feed to help evert the nipple.
A breast shell is a clear plastic case which sits in your bra. One side has a circular hole which fits over your nipple. The other side is curved away from the ‘nipple’ side.
The idea of using a breast shell for inverted or flat nipples is to apply constant gentle pressure to the nipple. This stretches the nipple and helps it to pull outwards.
Another benefit of using breast shells is they can prevent engorgement which causes flat nipples.
In pregnancy, you can use breast shell in the last few weeks to help draw out your nipples.
Once your baby is born, you can use breast shells for around 30 minutes before a feed. Any longer than this can be uncomfortable.
If you have a breast pump, it can be used to resolve your flat or inverted nipples. The strong and rhythmic suction of the pump can help to draw the nipple out.
Make sure you have a strong vacuum between the flange and the breast. You can do this by making your breast slightly moist with water or cream before you pump.
A breast pump can soften your breasts and make it easier for baby to attach well to the breast.
If you have no intention to express milk for your baby, you can pick up a manual breast pump for fairly cheap.
You can buy a small device called a nipple everter to pull your nipple out. It works by cupping a small tube shape over your nipple and squeezing a soft bulb. The Lansinoh Latch assist is cheap and easy to use.
You can also make your own everter device with a disposable syringe. A 10ml syringe is suitable for most moms. However, a 20ml can be used if you have large nipples.
This is how it’s done
- Completely remove the plunger from the syringe
- Carefully cut off the nozzle end of the syringe, so you are left with a long hollow tube
- Insert the plunger into to newly cut end
Push the piston in fully and place the smooth open end over your nipple. Gently and slowly pull the pull the piston back over 30-60 seconds. The pressure should pull your nipple outward with the piston.
Pregnancy Preparation for Inverted and Flat Nipples
The most important thing to remember is that flat or inverted nipples are not a problem for breastfeeding. They are simply a variation which you can work around, and still a great breastfeeding relationship. This advice will help you to prep for breastfeeding before baby is born.
Learn to Latch
One thing breastfeeding supporters will agree on is that your baby breastfeeds and doesn’t nipple feed. This is important because your breast tissue is a big part of attaching your baby to your breast. If this is done properly most flat or inverted nipples will be drawn out by your baby as they suck.
So the best piece of advice I can give you is to learn how to properly latch baby on. You can read our guide how to get the best latch here.
Once your baby is here, have a professional assess your baby’s attachment as soon as possible. This will prevent any problems that develop quickly from the poor attachment.
Breastfeeding is a huge learning process for you and your baby. You may think you know what to do, then add a squirmy crying baby into the mix and it all goes out the window.
The best way around this is by surrounding yourself with breastfeeding support. Ideally, I would recommend a professional lactation specialist. However, if you have a family member or friend who is experienced with breastfeeding problems they can also be helpful. Ensure they are helpful, supportive and encourage you to persevere when you feel like giving up.
Different breastfeeding positions can make it easier to latch baby on. Football hold, cross cradle hold are usually favorites as you have a lot of control to help your baby. Some moms find that laid-back breastfeeding helps the nipple evert better as gravity reverses the pull of the breast tissue.
If you suspect you may have issues latching baby on, it’s important to know how to hand express. This is because breastfeeding can become frustrating for your baby if they can’t feed. This causes your baby to cry which stresses you both out.
If you can hand express a few drops of colostrum or milk into baby’s mouth at the start of a feed, it will help to calm them. It’s also useful if your breasts are engorged causing your nipple to flatten.
Learn Feeding Cues
Once your baby is born, they will want to feed a lot. A newborn will feed between 8-12 times a day or more. That’s every 2-3 hours on average.
The reason your baby does this is to help establish your milk supply.
Feeding this often means your breast can get ‘engorged.’ This means they become so full of milk they are hard and swollen.
Your baby will give you cues that they are hungry and want to feed. Learning these feeding cues early will keep your baby satisfied and prevent engorgement.
Your milk supply will regulate itself quickly, and you’ll prevent sore breasts. It’s a win-win for everyone.
6 Flat or Inverted Nipple Breastfeeding Tips
These tips will help you to breastfeed with your flat or inverted nipples. You can use these suggestions individually or a combination of a few to assist your baby’s attachment to your breast.
1. Use a suction device
Just before a feed use a suction device to draw the nipple out. This can be any of the techniques discussed above including
- A breast pump
- Nipple everter
- DIY syringe everter
- Hoffman technique
Any of these can help to manually pull the nipple outwards. The effects are only temporary so try baby at the breast straight away.
2. Stimulate the Nipple
If your nipples are short or only slightly inverted stimulate them before a feed. Touching or rolling them between your fingers can make them protrude.
Making your nipples cold can also make them stand out. You can use a cold face cloth or an ice compress. Using ice should be used with caution as it can slow your let-down reflex.
3. Breast Shells
Around half an hour before a feed, use a breast shell over your nipple. This should be long enough to put the nipple outwards. Once it’s removed put baby to the breast to get the most benefit from use.
4. Hand Express
Before you attach your baby to the breast try dropping a few drops of milk into their mouth. This stimulates the suck reflex and can help baby to attach better. It usually has a calming effect on your baby so they are more patience as you help them to latch on.
5. Breastfeeding hold
Using a breastfeeding hold when feeding can help your nipple evert better. The ‘nipple sandwich’ is a great way to hold the nipple to get baby to attach properly. You can read more about this technique in our guide to the perfect latch.
6. Nipple shields
As a short-term measure you may consider using a nipple shield. It’s a thin plastic device which fits over your nipple. As baby sucks, it is pulled against the plastic and positioned the nipple perfectly in your baby’s mouth. Nipple shields can cause other issues, so I suggest getting professional lactation support for further advice. You can the guide to using nipple shields here.
Common Issues with Flat or Inverted Nipples
It is common for a flat or inverted nipple to hurt more when breastfeeding. You may notice this more if you have only one flat/inverted nipple and the other is everted. The most common reason is the pulling of internal adhesions as baby sucks. The good news is that this often eases over time. As baby feeds more these adhesions often stretch out and improve the inversion.
If the pain does not lessen over time, you should contact a professional to assess your baby’s attachment.
You may notice that your baby prefers to feed on one side over the other. This is really common with newborns. Your baby will always take the easiest way to get milk. If it’s a little trickier for them to latch on you affected nipple they will usually prefer the everted nipple.
Make sure you try all the techniques above before attaching your baby to the rejected breast. It’s entirely ok to feed on one breast. To prevent engorgement or mastitis, you will need to express from the other side.
Get professional help as soon as possible to help you get baby to attach to both breasts.
Slow weight gain
If your baby is losing weight or slowly gaining, it’s important to get a professional check your attachment. Poor weight gain means your baby is not getting enough milk during a feed.
If you have a good milk supply the most likely cause is the poor attachment. A good lactation expert will be able to help you with this. They may suggest using supplementation, so be prepared to express milk or using formula top ups.
If you are using nipple shields, you should stop. The lack of sucking directly on the nipple is known to cause low milk supply.