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Nipples come in all shapes and sizes and not all nipples point out away from the breast. Some nipples are flat while others are inverted and pull into the breast. Or, nipples may fall somewhere in between.
The amount of fat in your breast, the length of your milk ducts, and the density of connective tissue beneath your nipples all play a role in whether or not your nipples protrude, lie flat, or are inverted.
The shape of your nipples may also change during pregnancy. Sometimes, flat nipples push out during pregnancy and the first week or so after the baby is born.
It’s not uncommon for a woman to worry about breastfeeding with flat nipples. The good news is that with a little extra time and patience, breastfeeding with flat nipples is possible.
Here are 10 tips to help you breastfeed if your nipples are flat or inverted.
Many nipples will stiffen and protrude when stimulated. You can check to see if your nipples are truly flat or inverted. If you’re able to coax your nipples out, then chances are your baby will be able to, too.
Here’s how to check:
- Place your thumb and forefinger on the edges of your areola, which is the dark area around your nipple.
- Squeeze gently.
- Repeat on your other breast.
If your nipple is truly flat or inverted, it will flatten or retract into your breast instead of pushing out.
You can use the suction from a breast pump to help draw out a flat or inverted nipple if other methods to stimulate your nipples don’t work. This can be especially helpful if you have deeply inverted nipples.
There are different types of breast pumps available, including manual and electric breast pumps.
You may also be able to get a breast pump through your health insurance. Health insurance providers usually want you to purchase the pump through a specific vendor. Choices are usually limited, but often include popular brands. Call your health insurance provider for more information.
There are other suction devices that can be used for drawing out inverted nipples. These products are sold under different names, including nipple extractors or nipple retractors. They’re worn under your clothing and work by pulling your nipple into a tiny cup. Overtime, these devices can help loosen nipple tissue.
Sometimes, if your breast is very engorged with milk, it may feel hard and your nipple may flatten. Hand-expressing a bit of milk can soften your breast so that your baby can latch on more easily.
Here’s how to do it:
- Cup your breast with one hand, with your other hand make a “C” shape with your thumb and forefinger near the areola, but not on it.
- Squeeze gently and release the pressure.
- Repeat and try to get a rhythm going without sliding your fingers over the skin.
- Drops of liquid should appear just before your milk begins to flow.
- Express just enough to soften your breast.
Pulling back on your breast tissue may help when breastfeeding with flat nipples or inverted nipples. Even if the nipple doesn’t protrude completely, pulling back on the breast tissue can help your baby get a better latch. You do this by holding the breast tissue behind the areola and gently pulling back towards your chest.
A nipple shield is a flexible, nipple-shaped shield that fits over a mother’s flat nipple and areola. It is used as a temporary aid to encourage latching. The use of nipple shields is somewhat controversial because some has suggested that a nipple shield may reduce the transfer of milk and interfere with complete breast emptying.
Some experts also worry that the nipple shield can be addictive for a baby, causing some babies to prefer it over the mother’s breast. Improper positioning also increases the risk of damage or injury to the breast. Speak to a lactation consultant if you’re planning to use a nipple shield.
Breast shells are plastic shells that are worn over your areola and nipples. They’re flat and able to be worn discretely under your clothes between feedings to help draw out your nipples. They’re also used to protect sore nipples.
You may be able to coax your nipple out by gently stimulating the nipple yourself. Try gently rolling your nipple between your thumb and finger or touching your nipple with a cold, damp cloth.
You can also try the Hoffman technique, which was created to help women breastfeed with flat or inverted nipples. A 2017 study found that the technique effectively improved the nipple type and the quality of breastfeeding.
Here’s how to perform the Hoffman technique:
- Place your index and thumb on either side of your nipple.
- Press your fingers firmly into the breast tissue.
- Gently stretch the areola in each direction.
- Repeat five times each morning if you’re able to without pain.
You can also perform the exercise with both hands, using both of your thumbs.
Holding your breast while feeding can make it easier for your baby to latch on and breastfeed.
Here are two ways that you can try.
The C-hold allows you to control the movement of your breast so that you can easily guide your nipple toward your baby’s mouth. It also helps flatten your breast for a better fit in your baby’s mouth.
To do it:
- Create a “C” shape with your hand.
- Place your hand around your breasts so that your thumb is on top of your breast and your fingers are on the bottom.
- Make sure your thumb and fingers are behind the areola.
- Gently squeeze your fingers and thumb together, pressing your breast like a sandwich.
The V-hold uses your forefinger and middle finger to create a scissor-like shape around your areola and nipple.
Here’s how you do it:
- Place your nipple between your forefinger and middle finger.
- Your thumb and forefinger should be on top of your breast and your remaining fingers underneath the breast.
- Press down gently towards your chest to help “squeeze” out the nipple and areola.
You can make sure your baby is getting enough breastmilk by checking the diaper. Your baby should have frequent wet and dirty diapers. Around the time your milk comes in, your newborn should have six or more wet diapers each day and three or more stools per day.
If you’re having trouble breastfeeding or finding breastfeeding very painful, talk with your doctor or seek help from a lactation consultant.
If you live in the United States, you can find an international board-certified lactation consultant online on the United States Lactation Consultant Association (USLCA) website. For people outside of the United States, try the International Lactation Consultant Association.
If natural methods fail to work, surgery may be an option. There are two types of surgery for repairing inverted nipples. One type preserves some of the milk ducts so that you can breastfeed and the other does not. Speak to your doctor to see if surgery is right for you.
Breastfeeding with flat nipples is possible, though it can be difficult for some women. You can try a number of techniques and devices to coax your nipple out or talk with your doctor about surgical options.
In many cases, women with flat nipples will be able to breast feed without an issue. If you have concerns, consider speaking with a lactation consultant, who can provide in-depth strategies for breastfeeding.