Breastfeeding With Flat or Inverted Nipples

Breastfeeding, in the best of times, can be a challenge to most women who have just given birth. Everything from a mother’s diet to the shape of their nipples can impact both the baby and the mother immensely.

Many, when talking about childcare, have almost always overlooked nipples. Most people don’t notice how big a part they play when feeding unless they have themselves faced the problem of either flat or inverted nipples.

What Are Flat or Inverted Nipples?

The nipple is usually shaped perfectly to fit the baby’s mouth while breastfeeding thereby making it easy for the baby to feed. The shape of the nipple also plays a part in the nourishment of the baby. Outwardly protruding nipples usually makes sure the breastmilk is provided to the baby with ease. If the nipple protrudes inwardly the baby would have to suckle on the nipple harder and for longer. Inverted or flat nipples can make breastfeeding a harder and slightly more painful experience.

One of the major inconveniences of inverted nipples can be the baby’s inability to latch on to them well enough, which can mean they don’t get enough milk per feed. This can cause a deficiency in important nutrients during the feed.

What Are the Different Types of Inverted Nipples?

There are four different nipple shapes.

• Outwardly Protruding Nipples – These are considered the best for breastfeeding, as they are the easiest for the baby to latch onto and the most comfortable for them to feed on. These nipples are located a few millimetres above the areola, they are known to become more prominent when exposed to the cold or stimulated.
• Flat Nipples – The flat nipple blends right into the areola. It is harder for a baby to grasp or suckle onto this nipple but the circulation can still ensure sufficient nutrition for the baby. It becomes slightly more predominant when stimulated or exposed to the cold.
• Inverted Nipples – When your nipple retracts inwards, it makes it hard for your baby to find a way to suckle on it. Feeding with this nipple is quite difficult for the baby. The nutritional circulation for this type of nipple is poor and the baby may need external feeding or the feeding time may take longer than normal.
• Unilateral Inverted Nipples – When one nipple is inverted and another nipple is normal, you have what is called an inverted nipple. These can be easier to feed with compared to having both nipples inverted but it may prove strenuous to the alternative nipple.

How Do You Know If Your Nipples Are Inverted or Flat?

There are multiple small tests you can run to understand if your nipples are inverted; usually, you cannot tell they are inverted by looks alone. If your nipple retracts internally, it is safe to say you have inverted nipples.

However, an important point here is your nipple when resting can be of a different type than when feeding. This is why stimulation can also help identify if your nipples are completely inverted:

• When stimulated if the nipple protrudes outward, then you don’t have inverted nipples. Although it may seem like they are inverted, in this scenario you have outward protruding nipples
• If, when simulated your nipples stay flat or protrude slightly outward but not as prominently as with the protruding nipple, it is assumed you have flat nipples.
• Inverted nipples when stimulated still retract inwardly, this is the easiest way to know you have inverted nipples.

Can You Breastfeed With Flat Nipples?

Although it can be difficult, breastfeeding is possible with every type of nipple. These include flat and inverted nipples as well. Let’s have a look at the challenges for breastfeeding with all these types of nipples:

• The easiest and possibly most comfortable nipples to breastfeed are the outwardly protruding nipples. This is due to the shape of the nipple being perfect for the baby to suckle upon. The effort from both mother and baby is minimal.
• It is possibly the hardest for the baby to breastfeed with inverted nipples due to the increasingly difficult task for the baby to find and suckle on the retracted nipple. In most circumstances, the nutritional circulation of the mother when lactating will not reach the baby due to this condition. External feeding may be required.
• Flat nipples are slightly harder to breastfeed with, they are a bit harder for the baby to grasp and the baby may suckle in intermissions due to the shape not completely suiting the baby’s requirement. There isn’t a need, however, to feed the child externally as the lactating nipple is still accessible. The feeding session may take a slightly longer amount of time.

How Is Breastfeeding Affected by Inverted Nipples?

In the early stages of breastfeeding, it may become difficult for a woman to breastfeed due to the challenge of a baby to latch on or suckle an inverted nipple. However, women with inverted nipples can breastfeed. In some cases, the baby may not consume the entire breastmilk and may need formula to be fed to them externally. Talk to your physician to understand techniques that can be used to further help with breastfeeding. You can use breast pumps to help with inverted nipple breastfeeding.

How Flat Are Flat Nipples?

Flat nipples are usually level with the areola; these do not protrude at all unless stimulated. Even with stimulation, they protrude very slightly. Flat nipples are not harmful but can make breastfeeding slightly harder.

Treatment Options for Inverted or Flat Nipples

There are multiple non-invasive techniques to help correct inverted nipples:

• The Hoffman Technique: Use two thumbs on either side of your nipple to press firmly on the areolas. Push firmly against your breast and pull the thumbs away from each other. You can try this technique during your pregnancy and after childbirth as well. You can do this twice a day and then move up to seven times a day.
• Breast Shells: These are plastic hollow shells that can be worn inside your bra. They apply a light but consistent pressure to gradually draw out your nipples. While this can be worn during your pregnancy, it is best to use it only after childbirth. Do not use the breast shells for more than 30 minutes at a time and never while you sleep.
• Nipple Shields: These are made of soft silicone and do not interfere with the lactation. These are recommended only in severe cases of inverted or flat nipples and must be used under supervision.
• Breast Pumps: Using breast pumps to gradually draw the inverted nipple outward and helping it protrude can help combat and manage the condition.
  It is known to help ease the problem over long periods of time. These pumps can, if used on a regular basis, help break adhesions under the skin that sometimes cause inverted nipples. Breaking these adhesions can cure or improve the protrusion of the nipple.
• Cosmetic Surgery: Nipple correction surgery is a form of cosmetic surgery where the milk ducts that tether to your nipples are cut off. This surgery will make it impossible to breastfeed. Doctors recommend that women consider this surgery only after they are sure they no longer will breastfeed. This surgery can be completed between 30 minutes to an hour.

Tips to Breastfeed Your Baby With Flat Nipple

There can be few techniques to help breastfeed your baby with flat or inverted nipples. These should usually be done after consulting your primary care physician. Here are a few tips to help ease your feeding routines:

• Use the breast pump before a feeding session, this will help protrude the nipple and give the baby an easier shape to latch onto and suckle on.
• Talk to lactation specialists to help understand the functions and correct techniques of nipple shields and breast shells. These should strictly be used under the supervision of your doctors.
• Massaging your nipples using the Hoffman technique before and after the delivery of your child can help increase the prominence of the protrusion of the nipple.

It is recommended that any remedy or treatment implemented for inverted nipples should be done under the supervision of doctors and specialists. Your baby can receive nutrition through formula as there are no side effects. Talk openly to your lactation specialists for a complete diagnosis and treatment plan.

Also Read:

Advantages of Breastfeeding for Babies
Guide to Baby Latching
How to Breastfeed at Workplace