6 Tips for Breastfeeding with Inverted or Flat Nipples

Many mums often say to midwives in a passing comment at the end of an appointment “oh, by the way, I think I may have something wrong with my nipples!”

Having spoken to many women in my role as a lactation consultant I know that unfortunately lots of women are embarrassed if they think their nipples or breasts do not look “model perfect”...

I want to tell every woman that all breasts and nipples are normal in their own way, yet there are many variations. If you think about it, breasts and nipples are not a part of someone else that we see very often.

We can’t compare ourselves as we walk down the street looking at other women, and reassure ourselves that we are ‘normal’. The images we do see of breasts and nipples are often very similar.

Rarely will you see a nipple which is large or inverted and this can make us worry that there is something very different about us and that we may not be able to breastfeed.

So What is an Inverted or Flat Nipple?

About 10% of women have flat or inverted nipples. You can do a “pinch test” by gently compressing the areola just behind the nipple. If your nipple remains flattened or appears to pull in, then you know you have flat or inverted nipples.

Inverted nipples do not protrude from the level of the areola instead they are pulled inwards. Some nipples are known as a “true inversion,” this means that the nipple cannot be everted (pulled out), while others can be everted with stimulation or suction, such as with a breast pump.

Flat nipples are level with the areola. Again, some can be everted and others will stay flat.

Can I Prepare My Nipples During Pregnancy?

Treating flat and inverted nipples during pregnancy is debated in the studies, but some women find using Nipple Formers worn inside your bra to be helpful to draw out flat or inverted nipples. They can be started during pregnancy (from about 32nd week onwards).

Start wearing the Nipple Former for one hour a day and gradually increase to approximately 8 hours daily and also after birth between feedings (1/2–1 hour before breastfeeding). Avoid wearing at night to prevent tender spots and discard any milk which may have collected inside.

What Should I Do Once My Baby is Born?

Every woman’s nipples and every baby will feed differently so it is impossible to tell how breastfeeding will go just by looking at a mother’s nipples. Many babies feed well on nipples which may be flat or everted, while others need some extra time and assistance.

Here Are 6 Tips to Help When Breastfeeding with a Flat or Inverted Nipple

First, try to have skin to skin contact with you baby as soon as possible after birth and leave baby between your breasts for as long as possible. This will allow baby to use their innate reflexes which help them to find the breasts and self-attach. Feeding in a laid back skin to skin position may be really helpful for future feeds as well.

If your baby cannot attach and feed well then try bringing out your nipple just before feeding with hands on stimulation by rolling the nipples and “pinching” (gently) around the areola. A cold compress for a few minutes may be helpful to keep the nipple everted.

Use the breast pump just before feeds to pull out the nipple. The midwives may show you how to use a reverse syringe device (with no needle attached!) to help pull out your nipple as well.

Shape your breast before a feed. Compress your fingers a few centimetres behind your nipple to make a “V” or “C” shape. This can help baby attach deeper onto your breast tissue and feed well.

Use a nipple shield if the tips above do not work. Nipple shields are designed to help mums breastfeed babies with latch-on difficulties by providing a larger, firmer target for baby to attach and maintain attachment during the feed. Some mums find they only need to use the nipple shield for a short term as over time the frequent feeds help draw out their nipple, while other mums may need to use a nipple shield for longer.

Finally, remember to seek ongoing support from a breastfeeding specialist, especially in the first few weeks, until you are feeling confident with breastfeeding and you know your milk supply is good and baby is gaining weight well.

It’s normal to need lots of support in these first few weeks, never feel you shouldn’t be going to the clinic for frequent support. Most mums need lots of help and reassurance in the early days/weeks.

Do you know anyone who has had concerns about breastfeeding with inverted nipples? For more tips and helpful advice follow us on our Medela Australia Facebook.