You probably didn't pay too much attention to your nipples pre-pregnancy, but now that you're breastfeeding (or are pregnant and planning to breastfeed), you might give them a closer look.
Why? Because the way your nipples are shaped can impact breastfeeding. Having flat or inverted nipples might make it harder for your baby to get a firm grasp, and an improper latch can affect how much milk your baby gets and potentially decrease milk production.
While that may sound concerning, you shouldn’t panic. With the right care and attention, even those with flat or inverted nipples can breastfeed just fine. Here's what you need to consider.
What are inverted nipples?
Some nipples protrude out when you gently press on or squeeze the areola — the ring of pigmented skin surrounding the nipple. But when you pinch or squeeze the skin around an inverted nipple, it retracts inward instead.
Some nipples may not look inverted when you don’t try to compress them, while others might be slightly dimpled. It's possible to have inverted nipples all of your life and not know it until you begin breastfeeding. But in other cases, engorgement or swelling from IV fluids given during labor can cause temporary inversion.
If you're not sure what you’re dealing with, do the pinch test to check. Your nipple is inverted if it becomes concave instead of sticking out. Another way to spot an inverted nipple is if it doesn’t become erect when stimulated, like during sex or when exposed to cold.
If it seems like one or both of your nipples are inverted, you should let your OB/GYN or your baby's pediatrician know. An inverted nipple shape can make it tougher for babies to latch on, and in some cases, potentially affect milk flow.
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What are flat nipples?
Flat nipples neither protrude or retract inwards. Instead, they fall somewhere in the middle — giving them a flat shape that lays even with the rest of the areola.
Like with inverted nipples, it's not always easy to spot flat nipples just by looking at them. If you gently pinch or squeeze the areola and your nipple doesn't protrude but also doesn’t collapse inward, the nipple is considered flat.
And also like with inverted nipples, flat nipples can sometimes be a temporary issue caused by engorgement or swelling from IV fluids. Whether you notice nipple flatness before giving birth or it seems to develop afterwards, you should let your doctor know.
Can you breastfeed with flat or inverted nipples?
The good news is that your nipples' outward appearance has no effect on your breasts' ability to produce milk. The bad news is that a flat or inverted shape might make it harder for your baby to get a good latch and remove the milk efficiently. That can potentially result in him not getting as much milk as he needs, which can in turn negatively affect your supply.
In short, flat or inverted nipples can make breastfeeding a little tougher, especially in the beginning. But the American Academy of Pediatrics (AAP) and lactation consultants agree that in most cases, a less-than-ideal nipple shape doesn't have to stop you from breastfeeding.
Keep in mind, too, that not all women with atypical nipple shapes run into breastfeeding issues. In general, babies tend to have an easier time sucking from flat nipples than inverted ones. And a baby with a strong suck might be able to draw out a mildly inverted nipple all on her own. Premature babies or those with weaker sucks might have a harder time, especially with moderate to severely inverted nipples.
What can I do about flat or inverted nipples to make breastfeeding easier?
There are lots of techniques that you can use to help "draw out" your nipples or make them longer so your baby can latch easier. Start by talking with your baby’s pediatrician or a lactation consultant, who can help you navigate options like:
Get a deep latch and try different positions
Help your baby take in more of your nipple and breast by encouraging him to open his mouth wide and over the nipple. At the same time, try to gently push back on your breast tissue to encourage your nipple to stick out.
Once he's latched on, his nose should be touching your breast and his lips should be flared out, sort of like a fish. Experimenting with different positions, like a football clutch or cross-cradle hold, can often make latching easier.
Stimulate them
You may be able to coax your nipple out with some gentle stimulation. Try either touching your nipple manually or putting it against something cold.
Breastfeed often
Going too long in between nursing sessions can cause engorgement, which may make your nipples flatten or invert. Newborns should nurse on demand — typically every two to three hours, which should add up to eight to 12 nursing sessions over a 24-hour period.
Give reverse pressure softening a go
Gently massaging the areola with your fingers for a few minutes before nursing can help ease engorgement and make your nipple protrude more, making it easier for your little one to latch.
Do a pre-feed pump
Pumping for a few seconds before nursing can help lengthen your nipples.
Don't try to go long enough to actually get milk out unless your breasts are very engorged, and the engorgement is what's causing your nipples to flatten or invert. In that case, you could experiment with pumping to ease the engorgement just enough so your nipple protrudes and your baby can latch on.
Try a tool
Breast shells — hard plastic shells worn in your bra between feedings — could potentially draw out your nipples in the early days after giving birth. Used under the guidance of a lactation counselor or doctor, nipple shields can also help you achieve a better latch when breastfeeding.
Manual suction devices like LatchAssist are another option that you can use for a few minutes right before nursing.
Be proactive
If you know before giving birth that your nipples are flat or inverted, it's always a good idea to talk with your OB/GYN or your baby's pediatrician. While you don't have to take steps to address your nipple shape during pregnancy, you can take steps to prepare for any possible latching issues by finding a lactation consultant who you can reach out to once the baby arrives.
How to treat flat or inverted nipples that become sore
It’s normal to experience some soreness in the early weeks of breastfeeding, especially if you have flat or inverted nipples. Your baby may be putting extra pressure on the area as he tries to draw the nipples out, which could possibly damage the skin.
Sometimes the soreness will ease up on its own in a week or two as your baby gets the hang of nursing. But if that’s not the case, meet with a lactation consultant, who can help you adjust your positioning so your baby gets a better latch (and make nursing much more comfortable).
Take care, too, to keep sore nipples clean and dry in between feedings. If you have cracked or broken skin, trapped moisture could up the risk for infection. Soaking your nipples in saline solution three to five times a day can help reduce soreness and infection risk, too.
Flat or inverted nipples can sometimes set your breastfeeding journey on a bumpy start. But with a little bit of patience and help, you can absolutely make it work — and before long, get into a comfortable nursing groove.
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