Breastfeeding With Flat or Inverted Nipples

Is it possible to start breastfeeding with flat or inverted nipples? Below are some tips on how you can breastfeed even if your nipples may be flat or inverted.

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What are flat or inverted nipples?

Flat nipples are nipples that do not poke out very far when stimulated but instead stay tucked in close to the areola. Inverted nipples not only do not stick out but are tucked in, sometimes so far that they create a concave shape.

Both are fairly normal, but if you have flat or inverted nipples you might begin to worry about breastfeeding.

Is it possible? What might go wrong? What can be done to help?

What causes flat or inverted nipples… and how common are they?

In fact, around 9-10% of women have at least one inverted nipple, with even more women noticing flat nipples.

In both cases, the lack of point on the nipple is caused by short breast ducts and connective tissue inside, which sort of tethers the main part of the nipple down – inverted nipples are noticeably stuck down compared with the rest of the dark areola, or may be flush with it, where flat nipples have enough room to just about stick out past the areola but no further. 

These differences in nipple structure are considered genetic, so there’s probably nothing you could have done to cause it and it’s more likely that you have flat or inverted nipples if a family member is the same. 

How do you know if you have flat or inverted nipples?

When stimulated, a typical nipple sticks out quite a bit, so that it is somewhat comparable to the teat of a bottle or pacifier. 

A flat nipple, upon stimulation (whether this is massage or cold air), isn’t so restricted that dimples inwards, but does not poke out so much as a typical nipple either. It may not be very visible through a thin shirt or look much like a feeding bottle.

An inverted nipple dimples inwards at the center or doesn’t poke out whatsoever, even when stimulated. In fact, your nipples may retract in response to stimulation, instead of poking outwards.

If yours pulls inward, creating a hollow at the end, it’s inverted.

If you’re not sure, try a pinch test.

Compress your breast gently, with your forefinger and thumb placed on either side of the areola.

A typical nipple would poke out, so if yours protrudes inwards creating a concave shape – your nipples are inverted.

How inverted are my nipples?

Inverted nipples are sorted by grade. There are grades 1, 2, and 3. Grade 1 is the easiest to deal with, and Grade 3 is the trickiest. Here’s a breakdown.

Grade 1

A Grade 1 inverted nipple is occasionally/usually inverted but will (at least sometimes) become erect in reaction to stimulation.

Grade 2

A Grade 2 inverted nipple won’t become erect by itself but can be popped out manually (there are a few things we can try, they’ll be covered later).

Grade 3

A Grade 3 inverted nipple doesn’t become erect and can’t be pulled out manually. There are surgical options for those who’d like to correct their Grade 3 inverted nipple(s). 

Can you breastfeed with flat or inverted nipples?

The short answer is – yes, but sometimes you’re going to need a little help. Unless, of course, you have a Grade 3 inversion in which case your chances of feeding successfully are very slim.

It would be unusual for someone to know their inverted nipple was Grade 3 without having first had a go at manipulating the nipple in the ways one does when trying to breastfeed with inverted nipples, so if you would prefer to breastfeed it’s worth trying.

Breastfeeding is possible with flat or somewhat inverted nipples because the key to any good feed is a latch that goes past the nipple – so that baby’s mouth has taken in some of the breasts.

The only reason you might run into problems is that a baby’s sucking reflex is triggered by something firm and soft (a.k.a a nipple) pressing gently on the palate, so your little one might not know exactly what to do with a flatter or inverted nipple.

This could be more of a problem if your baby is premature or unwell – but you can always give it a go, or express it until the baby is feeling a little better. 

(P.S. If you would like surgical correction of a Grade 3 inverted nipple for the purposes of feeding, make sure to speak to your surgeon specifically about breastfeeding as only some surgical methods will help – and only some patients are good candidates for those methods.)

How do you breastfeed with flat or inverted nipples?

One of the things you can do to help is to prepare for breastfeeding during pregnancy.

As your breasts grow, you might find that your nipples begin to protrude by themselves, if not, consider using nipple formers.

Nipple formers are little silicone discs that go inside your bra and help to draw out the nipple, and they can be worn from 32 weeks (provided you do not have a weakened or “incompetent” cervix, or are at risk of early labor – in which case speak to your healthcare provider about them).

You can keep wearing them once the baby is here as well, and they can be especially effective in the 30-60 minutes before a feed. 

You can also try nipple aspirators, which encourage flat or slightly inverted nipples to pop out using a suction method.

Here are some formers and aspirators available to buy on Amazon.

Medela Nipple Formers

Ameda Nipple Shields

Phillips Avent Niplette

Nipple Sucker Nipple Corrector

If your baby seems to suck on other things for comfort but has trouble latching, it could be that your nipple is not reaching the palate. There are a few things we can do to try and remedy this. 

Firstly, check the latch. Is everything else as it should be, e.g is the baby positioned well on the breast?

Ask a lactation consultant or a trusted and experienced breastfeeding momma in your life to double-check for you.

If everything seems to be working but the sucking reflex still isn’t as active as it needs to be, have a go at one of the following:

  • Roll your nipple between your thumb and forefinger to stimulate your nipple and manipulate its shape.
  • Gently squeeze your breast behind the areola with your hand in a ‘V’ or ‘C’ shape to encourage the nipple to pop out.
  • Lightly applying a cold compress or piece of ice to the nipple in the hopes it will become erect.
  • Hand expressing or using a breast pump for a few minutes before baby attempts to latch.

If having tried everything on our list, you’re still having trouble – a nipple shield might help.

They’re only a short-term solution, but can be very useful for teaching baby what to do if your nipple doesn’t seem to trigger the sucking reflex.

Nipple shields are thin silicone typical-nipple-shaped caps with holes at the end that go over your nipple and areola to allow the baby to feed. Your little one latches on to the firm and pointy (yet still flexible and soft) shape, triggering their sucking reflex, and your milk comes flowing through the holes.

Moms who use nipple shields recommend wetting the edges slightly before use so that they stick well to the skin.

If you’re using nipple shields, ask your lactation consultant to double-check your latch. You should also keep a close eye on baby’s weight gain to ensure that they’re getting everything they need.

Here are some nipple shields available on Amazon:

Medela Nipple Shields

Hakka Nipple Shield

MAM Nipple Shields

If none of the options we’ve gone over work for you, but you’re still keen on the benefits of breastmilk over formula you might like to draw your milk out with a pump and bottle-feed it to your baby.

This can be done exclusively or in combination with formula and/or breastfeeding. 

As long as the end result is a happy baby with a full tummy, it’s ok to feed your little one in whatever way works best for your family.

Caring for flat or inverted nipples while breastfeeding

Yay! You did it! You’re regularly breastfeeding your child with flat or inverted nipples. Well done, you’re amazing. There are a few things to look out for, just to make sure you’re as happy and healthy as your baby. 

All breastfeeding boobs get sore, and many are dry (some even crack) – but you may need to be even more vigilant with your nipple balms and creams since any extra manipulation of the nipple you need to do to get your baby fed can upset the already sensitive skin.

As well as this, if you find that when you’re done feeding your nipples retract back to a very flat or inverted state any moisture that was on there gets trapped. This can lead to more dryness, and to infections like thrush.

Gently wipe your nipples and dab them dry after every feed and keep a close eye on them for any signs of infection.

If you suspect something is wrong, speak to a lactation consultant or your healthcare provider.

However you feed your baby, we wish you the best of luck on this beautiful, crazy journey!

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