Breastfeeding with Flat or Inverted Nipples
Everybody is unique and beautiful. No two people are exactly alike. Yet, many of us share similarities. When we notice a physical trait in our bodies that isn’t considered “normal,” we feel alone. Too many mamas with inverted nipples feel alone and are worried that this problem means they are somehow broken and unable to breastfeed. In truth, inverted and flat nipples are relatively common. And you will most likely be able to breastfeed. There are solutions, and your breastfeeding support team has helped other mamas overcome this same problem, and they will help you too!
Identifying Flat or Inverted Nipples
The terms flat nipples and inverted nipples refer to the way the nipple protrudes. Sometimes, this is visible all the time. In other cases, you don’t even know until you’re looking for it, such as when you first attempt to breastfeed.
Flat nipples can be flat against the areola and still protrude when prompted. This is common and is not what we are referring to as inverted nipples. This shouldn’t create any roadblocks when trying to nurse.
Photo credit: Farber
To be inverted, the nipple will not protrude when the areola is gently squeezed. It might retract just slightly, to be flush with the areola, or even further inward. This happens because of tight, slightly fused tissue beneath the areola and nipple. Both nipples might be inverted, or just one, or at different amounts of tension.
Not to worry – as La Leche League reminds us – we breastfeed, not nipple feed.
Nipple Prep During Pregnancy
Inverted nipples don’t have to stop you from breastfeeding, especially if you discover that you have them during pregnancy. The earlier you realize this, the more time you have to gradually pull them out.
Depending on the severity of the inversion, you may or may not even notice a problem breastfeeding. Honestly, slight inversions are usually improved when you start nursing, and your baby has a good latch. For more prominently inverted nipples, you’ll need to gently stretch and work the nipple and areola tissue to help release the tension that is pulling it inward.
Talk with your midwife right away about how to proceed and discuss the best way to work with your body to prepare for breastfeeding.
- Breast massage will help loosen any tight tissues and is suitable for all breastfeeding moms to improve circulation and general breast health.
- Nipple Massage- Gently press your thumb and forefinger down at the base of the nipple and pull to stretch the tissue outward. Don’t overwork your tissues – Do this a few times every day.
- Use a Latch Assist or a Nipple Bell to gently pull your nipple out a little during pregnancy and latter when you are breastfeeding. The Nipple Bell is a small suction cup that safely pulls your nipple out. Like the nipple massage, be mindful not to overdo it. Using it a few times every day is usually sufficient.
- Use a nipple shell in your bra, which presses onto the nipple to help stretch the tissue. A nipple shell is a round plastic shell that applies pressure at the base of your nipple, pressing it and causing it to extend. The nipple shell is very helpful later, too, when you are breastfeeding, and you want to protect your nipples from fabric rubbing on your sore nipples.
- Use a breast pump to pull out the nipple gently.- Use caution here and discuss this with your midwife. You only want to pump if you are past your due date. We wouldn't want you to stimulate contractions too soon!
Using a Nipple Shield While Breastfeeding with Flat and Inverted Nipples
A nipple shield is a thin, silicone nipple that can be placed over a mother’s nipple and may help a baby learn to breastfeed. Holes in the tip allow milk to flow into the baby’s mouth. A nipple shield can be used temporarily to help establish breastfeeding or, in some cases, to ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby’s mouth where the soft and hard palate meet. This can help him suckle more effectively.
Remember, you and your baby are learning how to nurse together! Expect to have sore nipples in the early days of breastfeeding with our without inverted nipples. If you have inverted nipples, you probably will not actually need a nipple shield. However, nipple shields are often the first advice our well-meaning friends and family will suggest.
I encourage you to try to nurse without the nipple shield, if at all possible. Remember, directly breastfeeding with inverted nipples stretches the tissue. It is helpful to pull out your nipple before you nurse with either the nipple bell or the breast pump. You want the baby to latch well and pull that tissue loose, and nipple shields do not address the issue. Nipple shields can prolong your problem if not used properly. They are notorious for sore nipples, low supply, poor weight gain, and other breastfeeding complications. So, avoid the shield, if at all possible. If you do need it, know that it is only a temporary solution and plan on weaning off the shield as soon as possible.
The goal is to get the baby to have a nice deep latch that can help them to pull milk in despite an uncooperative nipple complex. It can also help to draw the nipple out over time. To do this, align the baby's nose with your nipple. Pull back on your breast tissue to make it easier for him to latch on. Tickle baby's lips with nipple and wait for the baby to open wide(like a yawn). Then latch him on, assuring that baby has the nipple angled toward the back roof their mouth, most of the areola is in their mouth, and their lips are phalange.
Learning to Breastfeed is a Process
Until the nipple stretches out, both of you will get frustrated. When this happens, take a deep breath. Remember, it’s totally okay to let your baby calm down, then try again after she’s been soothed. Try to be patient with yourself and your baby – take your time and don't rush through this process; it requires the grace of a mother.
Yes, you have to figure it out in your own way, but you do not have to do it alone! Reach out to an IBCLC certified lactation consultant, your care provider, or a La Leche League Leader if you need help getting into the rhythm of latching and breastfeeding with inverted nipples.
How to Treat Sore Nipples
As the tissue pulls and stretches, or you inadvertently latch shallow or “chomped,” soreness is inevitable. The most obvious way to relieve the pain is to perfect the latch! But beyond that, here are 4 simple tips to help soothe your nipple pain.
- Air Out- Go topless when you are in the privacy of your own home. Fresh air and sunshine are healing for cracked and chafed nipples. Sore nipples can heal faster when they are not cooped up under layers of clothing and breast pads.
- Squirt Breastmilk on them. Massage your breastmilk and colostrum on your breasts.
- Apply cool compresses. Compresses can be bought a the store, or you can make them yourself with herbs. Either way, they are soothing, and many women love them. For ideas about how to make your own herbal nipple cold nipple pads check out our DYI Padsicle Post for Sore Nipples.
- Herbal Nipple Salve blended with Calendula and Plantain is formulated with food-grade ingredients and organic herbs. It is safe for babies to ingest. You can apply a small amount to your sore, cracked, nipples to bring much-needed relief.
Another challenge with inverted nipples is that when nipples remain inverted, they can retain moisture, leading to more chafing and discomfort. Our Nipple Salve contains anti-inflammatory, anti-fungal, and antiseptic herbs and forms a moisture and friction barrier that is meant to prevent this kind of damage.
Remember, you are a good mom! You are finding solutions, and you are figuring out how to nurse your baby in spite of having inverted nipples! Be proud of yourself! I'm very proud of you!
Read our other breastfeeding blogs to support your journey!
Hugs, sweet mama! Remember to let your love and your milk flow!