Breastfeeding with inverted or flat nipples may cause problems with latching in some women. However, learning some latching techniques and proper positioning can help you breastfeed your baby adequately (1). Regular practice can also help the baby latch on the areola and feed well. Some women may consider maneuvers and devices designed to help those with inverted or flat nipples feed their babies comfortably.
This post tells about the causes, techniques, and tips for effective breastfeeding with flat or inverted nipples.
What Are Inverted And Flat Nipples?
A nipple that points inward instead of outward is called an inverted nipple (2). It means the nipple does not protrude above the skin of the areola. The nipple that is not raised and lies even with the areola is called a flat nipple. Some women can have a unilateral (only one side) flat or inverted nipple. Some may have both sides involved.
Looking at the nipples may not help you to identify the flat or inverted nipples. You may do a pinch test to determine it. The pinch test is done by gently compressing the areola (dark area around the nipples) nearly an inch behind the nipple.
Nipples that are not erect during compression are considered flat nipples. Whereas an inverted nipple may become concave or retracts during a pinch test. True flat or inverted nipples may also not become erect when exposed to cold or when stimulated. Nipples that become erect during a pinch test, exposure to cold, or any stimulation are not true flat or inverted nipples.
Causes Of Flat And Inverted Nipples
Tight adhesion of breast tissues to the base of nipples causes inverted or flat nipples in women. In most cases, nipple inversion and flatness can be present from birth. The condition that may interfere with the normal shape of nipples later in life may include the following (3)
- Duct ectasia is the thickening and widening of milk duct walls
- Breast cancer, including Paget’s disease
- Periductal mastitis is the inflammation and infection of the engorged milk duct
- Fibrocystic breast disease is non-cancerous lump formations inside the breast
- Scarring or loss of fat in the nipple area due to injuries or surgeries
- Tuberculosis may affect breasts in rare cases
Other than nipple inversion or flatness, some women may have retracted nipples due to these pathologies. Nipple retraction is a condition causing only part of the nipple to turn inwards. You may seek medical care and take mammograms if you notice changes in nipples.
Are Flat And Inverted Nipples Permanent?
Flat or inverted nipples may stay unchanged in some women. While in some women, nipples become protruded during pregnancy and childbirth due to hormonal changes. Some women may notice changes in nipples only when it is stimulated.
Does An Inverted Nipple Interfere With Breastfeeding?
Moderate and severely inverted nipples may interfere with breastfeeding. However, improper latch and feeding position can be a more common cause of breastfeeding problems than nipple pathologies. With proper techniques, most women with flat and inverted nipples can overcome the nursing problems.
Degrees of inversion and its effect on breastfeeding may include the following (4).
• A slight or lesser degree of inversion does not interfere with breastfeeding. A full-term baby can suck and draw the slightly inverted nipples out and feed well. Premature babies with weak reflexes may face problems in the initial days of feeding.
• Moderate to severe inversion may interfere with latch and breastfeeding. However, treatments and deep latch techniques can help most babies to feed well. Nipple shells and shields can also help the mother to feed the baby adequately.
Treatments And Techniques To Improve Latch With Flat And Inverted Nipples
It is recommended to seek advice from a lactation consultant to establish strategies to feed your baby well with inverted or flat nipples. You may also pay attention to baby diapers per day to ensure that they are fed well.
Some breastfeeding experts may recommend treatment for flat or inverted nipples, and many women may find it helpful. Below are the various treatments and techniques to improve latch with inverted or flat nipples (4).
1. Modified syringe and breast pump
Breast pumps, modified syringes, and other devices that pull to elongate the nipples can be used immediately before nursing. This may help the baby latch well. These devices can be used each time you wish to breastfeed.
2. Breast shells
Breast shells may help draw the inverted or flat nipples out. It is made of two plastic pieces and can be worn inside the bra. The hole in the inner piece fits over the nipples, and the pressure exerted around the nipples may result in the protrusion of the nipple through the hole.
Wearing breast shells during pregnancy can be beneficial since the skin elasticity due to pregnancy hormones can help to stretch the breast adhesions. After childbirth, it is recommended to wear breast shells half an hour before breastfeeding. You need not save the breast milk collected while wearing them and do not wear them at night.
3. Nipple stimulation before feedings
Nipple stimulation before feeding may help the baby to latch well and often help the nipples to protrude. You may gently roll the nipples between your thumb and index finger for a minute or two and touch the nipples with a cold or moist cloth. This may cause nipples to become erect. Do not place the cold or moist cloth on the nipple for too long since it may cause the nipple to feel numb and may interfere with the let-down reflex.
4. Reverse pressure softening
You may push the nipple toward the chest wall for one to three minutes by placing a finger and thumb around the base of the nipples. You may do so before breastfeeding to make the nipple erect and stimulate milk flow. Reverse softening makes it easier for the baby to latch on.
5. Pulling back the breast tissue during latch on
It is recommended to slightly pull the breast tissue toward the chest wall during latch to protrude the nipples. You may support the breast with your thumb on top and other fingers underneath during the latch.
6. Nipple shields
A flexible, thin silicone nipple that can be worn over the nipples is called a nipple shield. A hole in its tip allows milk to flow to the baby. If other methods are not working, using a nipple shield can help your baby latch and feed well. It can stimulate the roof of the baby’s mouth and stimulate the sucking reflex. It is recommended to use a nipple shield under the guidance of a lactation professional since improper use could result in complications.
7. Breastfeeding position and latch-on techniques
Learning breastfeeding skills from an expert can help nursing mothers with flat or inverted nipples. Experimenting with various positions can help to find the most comfortable feeding positions for you and your baby. Some mothers feel the clutch hold (football hold), or cross-cradle hold helps the baby latch well.
8. Hold breast while latching
You may use C-hold (palmar grasp) or V-hold (scissor grasp) to latch your baby well. In C-hold, the breast is placed on the palm, and the thumb is kept on top, and the fingers are placed underneath the breast. This helps you to direct the nipple toward your baby’s mouth. C-hold is often recommended for women with large breasts and small hands.
Nipple and areola are placed between the index finger and middle finger in a V-hold, like a scissor. Thumb and index finger should be placed on top and other fingers placed under the breast. Women with large hands and small breasts find V-hold more comfortable than C-hold.
9. Hoffman technique
Hoffman technique may help to draw out the flat or inverted nipples. In this technique, you may place the thumbs on the right and left edges of the areolas (depending on the breast) and press the breasts inward and pull them outwards. This maneuver can be repeated four to six times. Repeat it again, but this time keeping thumbs on top and bottom of the areolas.
10. Express milk
Nursing mothers with nipple abnormalities, especially severely inverted nipples, causing latching problems could consider expressing milk. You may express milk with a breast pump or hands. Seek advice from a lactation consultant to know methods to express and store breast milk for your baby.
11. Surgical options
Various surgical techniques are used to correct flat or inverted nipples. The creation of epithelial or dermal (skin) flaps and sutures help to restore nipples’ normal appearance. However, the surgeries are recommended for severe cases since this can lead to complications such as loss of sensation, lactation function loss, and recurrence.
There are various products available in the market that are designed to evert and lengthen the nipples. It is better to seek a healthcare expert’s help while choosing strategies to manage inverted or flat nipples while nursing.
Treatment For Nipple Soreness In Women With Flat Or Inverted Nipples
Many mothers with inverted or flat nipples may experience nipple soreness during the first two weeks of nursing. This can be due to the stretching of adhesions while the baby sucks. The following tips may help to reduce nipple soreness in the initial weeks of breastfeeding.
- Practice maneuvers and latch positions recommended by the lactation professional.
- Use a cold or warm compress on the nipple.
- Use a lactation-safe nipple cream after feeding sessions.
- Keep the nipple area dry and clean. Pat dry instead of rubbing vigorously.
- Express milk to avoid engorgement if you are unable to establish a latch due to soreness.
- Take lactation-safe pain relievers as per doctors’ recommendations.
It is recommended to seek help from an expert to manage severe soreness or soreness that lasts for more than two weeks.
Flat or inverted nipples could be a natural occurrence in many women. Experts state that hormonal changes during pregnancy and childbirth could help many mothers’ nipples protrude naturally. In any case, do not worry about slightly inverted or flat nipples before breastfeeding. Discuss with your doctor to know the best breastfeeding strategies for you based on individual factors.
2. Inverted Nipple;U.S. National Library of Medicine
3. Inverted nipple;HealthGrades
4. Inverted and Flat Nipples;La Leche League International