Breasts, just like the women who own them, are different. No two breasts are the same, from woman to woman or left to right. That wonderful variety of shapes, sizes, textures and lay also applies to nipples. Like the breasts themselves, nipples are individual and each one lends its own personality to your breastfeeding journey. While I am going to write an article regarding breast and nipple types, and how they may or may not affect breastfeeding, a recent question has led me to compose this stand alone piece. Is breastfeeding with flat or inverted nipples possible?
What are flat or inverted nipples?
Common nipples protrude away from the areola with stimulation, either from arousal, cold or compression of the milk ducts. True flat or inverted nipples do not do this. Instead, flat nipples stay flat while inverted nipples retract, depending on the severity of the inversion.
A true inversion is caused by adhesions that have formed at the base of the nipple which prevents the nipple from protruding completely.
How common are flat or inverted nipples?
A quick search regarding the prevalence of flat or inverted nipples produces a wide range of answers. Some claim that as many as 20% of all women suffer some type of inversion after pregnancy while others say 10%. This 1997 study found that 9.8% of women (there were only 3006 participants in the study) presented with either bilateral or lateral reduction in elasticity of the nipple, which is jargon for flat or inverted nipples.
Despite the various answers, taken as a whole, it appears that some degree of inversion, either full inversion of the nipple or flatness, is rather common. In fact, before pregnancy, it is estimated that one third of all women have some degree of inversion caused by adhesion formation. Yet during pregnancy, the breasts become more elastic and those adhesions can loosen or break, resulting in full protrusion of the nipple when needed. Sometimes, that loosening or breaking does not occur, resulting in the 10% estimate given above.
How can you tell if you have flat or inverted nipples?
Looking at your breasts may not tell you if you have flat or inverted nipples, even if they appear so on a visual inspection. Instead, a pinch test is required.
If you want a PDF of the above infographic, click here.
To perform a pinch test, simply take your thumb and forefinger and press about about an inch behind your nipple, then gently push backwards toward the chest wall. Flat nipples will remain flat while inverted nipples will appear retracted or even concave.
Breastfeeding with flat or inverted nipples is entirely possible
I am not saying it will be easy. While babies do not NIPPLE feed, the nipple (obviously) plays a large role in breastfeeding – and it’s shape will affect the outcome. A common nipple that protrudes away from the areola with stimulation offers the baby a target. They can grasp it easier, then, per natures design, manipulate it towards the roof of their mouth while taking in large amounts of breast tissue in order to compress the milk ducts with their mouths.
Imagine a beach ball. It has a one way valve that lets air in, yet prevents air from leaking out unless pressure is placed beyond the valve. When you want to deflate that ball, you don’t just press on the valve. If you do, you’ll get some air out – but it won’t be a lot and you won’t deflate that ball easily. No, you press higher, just past the valve. The air will suddenly come out in a steady stream – just like with breastfeeding. The valve (nipple) matters, but it’s where you press that matters more.
Like the beachball, however, if the nipple (valve) doesn’t extract completely, there can be problems. Though unlike the beachball, there are treatments for flat or inverted nipples.
To treat or not to treat?
If your Doctor, Lactation Professional or Nipple Pinch Test has told you that you have either one or two flat or inverted nipples, then you may start considering treatment options.
Not every case of inversion or retracted nipples requires treatment. As pregnancy progresses, the breasts gain elasticity, allowing the adhesions that cause inversion to loosen. Some women may find that a nipple that appeared inverted prior to pregnancy, even one that showed inversion on the Nipple Pinch Test, has become a common nipple with stimulation over the course of gestation. For others, the inversion will remain, though their babies will be able to nurse just fine with little to no help. Yet for some moms, treatment will be required to ensure adequate breastfeeding. While a visit to your local Lactation Professional is advised, there are some home remedies you can also attempt.
At home treatment for flat or inverted nipples
While some prenatal treatments will be mentioned below, please be aware that nipple stimulation can induce labor in some women. Consult your Doctor, Midwife or Lactation Professional before attempting any of the following.
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Flat or inverted nipples can be treated either during pregnancy or after in multiple ways:
The Hoffman Technique
Introduced by Dr. J. Brooks Hoffman, the Hoffman technique is a manual manipulation exercise that encourages the adhesions to release and draw the nipple out. This can be done during pregnancy (with the above caution in mind) or after delivery.
- Place thumbs on both sides of your nipple – not the areola.
- With firm pressure, press down then pull your thumbs away from each other.
- Repeat this same motion all around the nipple
This can be performed whenever you choose, though at least once a day is advised for optimal results. The Hoffman technique has been around since the 1950’s and there are many moms out there that swear by it. That said, there is little scientific evidence that this works, so if you do not find the results you are looking for, do not be discouraged.
Unlike nipple shields, Breast Shells are worn between nursing sessions or during pregnancy. Their special shape and design allows them to gently pull the nipple out, encouraging adhesions to release over time.
Small, light weight and easy to use, Nipple Everters look like miniature suction bulbs. Simply compress the bulb, place the open end over the nipple then release the bulb. The pressure helps pull the nipple out, though repeated use may be needed.
There are a few different varieties on the market, but my favorite is the Lansinoh Latch Assist Nipple Everter. I used it with my eldest. You can see it sitting behind me on the couch in the picture below – I have circled it in red. As for my expression…. what can I say? I had a newborn and my husband was trying to take my picture… I was NOT in the mood, lol!
Like the Nipple Everter, the goal of using a Breast Pump in this manner is to extract the nipple to allow easier latching. You can use any pump you have on hand – place it over the nipple, pump until the nipple is extracted then nurse.
For Battery or Electric Pumps, the Ameda Finesse Double Electric Breast Pump has a proven track record and offers a closed system (meaning that the breastmilk doesn’t go into the actual machine, preventing mold formation in un-cleanable parts) and is available through your insurance. For more information, please follow this affiliate link. The Areo Flow website also offers multiple other pumps available via insurance. They will walk you through every step in the process. It is definitely worth checking out.
In my practice, I very rarely recommend Nipple Shields – mainly because they are hard to break away from. A baby may become accustomed to the mouth feel and a mother may suffer from lack of stimulation and sensation, resulting in reduced breastmilk output over time. However, there are cases when a nipple shield is helpful and even advisable. In the event of extreme nipple inversion, a nipple shield may offer a short term solution when used in conjunction with other nipple extraction methods.
Please see a Lactation Professional in order to determine if a nipple shield is right for you.
Those that suffer from flat or inverted nipples may find that their nipples become sore, red and irritated. This is due to the moisture that is trapped on the nipple surface when it retracts after a breastfeeding session.
To treat this, after nursing, apply either olive oil or a baby safe ointment like lanolin. You can also wear Breast Shells, like the ones mentioned above, in order to keep your nipples extracted, helping to prevent the moisture accumulation from causing irritation.
You may also find that your nipples are sore as your Breastfeeding Journey lengthens. Often, we consider nipple or breast soreness with breastfeeding to be caused by a poor latch, yet in cases of Nipple Inversion, it may be due to the adhesions breaking. The more you breastfeed, the more often your nipple will be pulled out by your baby’s suckling. This places more pressure on the adhesions, encouraging them to loosen and break. While this is great news for future pregnancies and nursing potential, it can cause pain NOW.
If this happens to you, you can use cooling gel bags, lanolin, warm compresses and time. If the pain does not improve, or worsens, please see your Lactation Professional.
Breastfeeding with Flat or Inverted Nipples is very, very possible. It can be a bumpy journey, but with a little foreknowledge and some help, your nursing adventure can be bright and fulfilling.