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 nipples 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.
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.
If your nipple protrudes, that’s great. In the case that it does not protrude or become erect, it is considered flat. If it retracts or disappears, it is truly inverted. Nipples that are severely flat or inverted will not respond to stimulation or cold by becoming erect. If you perform the pinch test and your nipples protrude, they aren’t truly inverted and will probably not cause any problems when you nurse your baby.
A truly inverted nipple is caused by adhesions at the base of the nipple that bind the skin to the underlying tissue. While the skin does become more elastic during the third trimester of pregnancy in preparation for nursing, some of the cells in the nipple and areola may stay attached. Sometimes the stress of vigorous nursing will cause the adhesion to lift rather than stretching or breaking loose, and this can cause cracks in the nipple tissue and pain for the mother.
Because the breasts function independently of each other, it is not unusual for a mother to have one flat or inverted nipple, or to have one nipple that protrudes more than the other. For the same reason, it is not unusual for a mother to produce more milk from one breast than the other.
Another simple way to tell if you have an inverted nipple is that if your nipple protrudes at all—naturally or when stimulated by touch or temperature—you do not have an inverted nipple.
The Hoffman Technique
The most common manual treatment for inverted nipples is the Hoffman Technique, but it’s important to note that studies show conflicting evidence as to whether or not this technique works—and for how long
Here’s how to try it yourself:
- Place your thumbs at the base of either side of your nipple and press firmly into your breast tissue.
- While pressing down, pull your thumbs away from each other.
- Move your thumbs all around the nipple and repeat.
- Repeat once per day.
The Hoffman Technique is a manual exercise that may help break adhesions at the base of the nipple that keeps it inverted. Place the thumbs of both hands opposite each other at the base of the nipple and gently but firmly pull the thumbs away from each other. Do this up and down and sideways. Repeat this exercise twice a day at first, then work up to five times a day. You can do this during pregnancy to prepare your nipples, as well as after your baby is born to draw them out.
Is it a deal-breaker if I have an inverted nipple?
An inverted nipple is definitely not a deal-breaker for you!
““Remember that babies BREASTfeed, not NIPPLEfeed” — La Leche League
When breastfeeding, the baby should open up wide enough that he/she takes a good portion of the breast into his/her mouth, bypassing the nipple entirely. Because of this, in most cases, inverted nipples alone will not cause problems with breastfeeding.
When Inverted Nipples May Interfere With Breastfeeding
Inverted nipples can make it more difficult for some women to breastfeed. In rare cases, a mother can experience persistent sore nipples because the baby compresses the buried nipple rather than compressing the milk ducts. The result is little milk for the baby and a painful experience for the mother.
Breastfeeding is more likely to be a challenge for women with inverted nipples based on:
- Degree of inversion: If mummy has a slight inversion—the most moderate case—a baby with a normal suck is unlikely to have a problem feeding. If mama has moderate to severe inversion—when the nipple retracts deeply into the areola—baby may have more trouble compressing the milk ducts. The good news is that breastfeeding is usually possible, no matter how inverted the nipples are. Consult an IBCLC lactation consultant for help establishing a proper latch and have patience with yourself and your baby.
- Other latching issues: When combined with other latching issues, like tongue tie or lip tie, mama and baby are much more likely to have problems with breastfeeding.
Studies support the use of suction devices—shells, cups, and nipple extractors—for drawing out inverted nipples. They are worn for longer periods of time (over the course of the day, for example), and are meant to loosen the nipple tissue to help nipples stay erect for longer periods of time.
Try an automatic double electric breast pump, which uses uniform suction from the centre of the nipple to draw it out rather than compressing the areola. Over time, the suction usually works to break the adhesions that are holding the nipple in.
A nipple shield—a thin, flexible silicone shield that’s shaped like a nipple and has holes in the tip to allow milk to flow to the baby—can also help. These devices are used during feedings to help draw the nipple out. (Consult a lactation consultant before attempting to use the shield, as it can frustrate the baby and lead to further problems if not used correctly.)
Breast shells are another wearable item that can assist nipple profusion, but unlike the shield, are not used during feeding. Instead, they are worn inside your bra for about an hour before feedings to draw out the nipple.
Other #SLBHacks for Inverted NIpples
- Regular nipple stimulation: Before feedings, roll your nipple between your thumb and index finger for 1-2 minutes. Follow up with a damp cold cloth or with ice that has been wrapped in cloth. Keep in mind, you don’t want to ice the nipple to numbness as this can inhibit your let-down reflex.
- Manually pulling back breast tissue: As the baby goes to latch, place your thumb on top of your areola and your other four fingers underneath it. Pull the breast tissue towards the chest to help the nipple protrude.
- Reverse pressure softening: Before baby latches, place all five fingers around the base of the nipple. Push towards the chest for 1-3 minutes. This may help the nipple protrude and trigger milk flow.
- Ensure baby gets a deep latch. When a baby is latching, hold him/her close and align the baby’s nose with your nipple. Pull your breast tissue back, tickle the baby’s lips with your nipple, and wait for the baby to open wide. (
- Get help. A certified lactation consultant can help. You can also attend La Leche League Singapore or Breastfeeding Mother Support Group or feel free to join SLB’s Breastfeeding Facebook Support Group. These are free of charge and is a place for breastfeeding support. Reach out sooner rather than later to avoid unnecessary stress and frustration for both mummy and baby.
Last by not least
Nipple inversion can make breastfeeding more challenging for some mummies, but it doesn’t make it impossible. If you’re having trouble, give yourself some grace—breastfeeding is hard! If you can get help and stick with it, the benefits are great. But occasionally, breastfeeding becomes too much stress for you or your baby, and it just doesn’t work out.