Can I Breastfeed if I Have Inverted or Flat Nipples?

Many women think that having inverted or flat nipples mean that breastfeeding will be impossible. They are often told, “It will hurt too much” or “Your baby won’t be able to latch” or “Your baby won’t be able to get enough milk.” The good news is that this is often not the case and nursing can be successful.

Flat nipples are just that: they do not protrude from the areola. Inverted nipples come in two variations: retractile (where the nipple can be pulled out or everted) and invaginated (where the nipples truly are inverted and cannot be pulled out).

Nipples that appear flat or inverted during a breast exam are not a true indicator of what they really look like during breastfeeding. When a baby is latched on, on average the nipple doubles in length! Even using a pump to see what the nipple appearance is during breastfeeding is not perfect, since the suction of a pump does not accurately reflect what happens during nursing.

If a woman has inverted or flat nipples, seeing a lactation consultant before she delivers may be helpful to get more information and troubleshoot before any issues arise. Some old methods of “preparing” the nipples during pregnancy (such as wearing breast shells or stretching the nipple during the pregnancy to try and break up adhesions and help the nipple evert) have not been shown to work and should not be recommended.

The best thing a woman in this scenario can do is to start breastfeeding and see what happens! It sounds simple, but by tracking her baby’s wet and dirty diapers she can determine if her baby is getting enough milk. This, in combination with a comfortable latch, can help her rest assured that her baby is most adequately attached to the breast and feeding well.

If latching is an issue and a woman has flat nipples, stimulating the nipple before a feed (either by pumping, using a cold washcloth, or massaging it) can help temporarily evert it long enough to help baby to latch on. For those with inverted nipples, pumping as well as pushing back towards the chest approximately 2 centimeters from the nipple can help give the baby more tissue to latch on. A lactation consultant can help demonstrate this technique.

Nipple shields can also be used if latching is a problem. These flexible shields are worn over the nipple and areola and help to give the baby more to latch onto. However, it is important to use these only after a thorough evaluation with a lactation consultant, since they are occasionally recommended when they are not needed and can lead to decreased milk transfer if not appropriately managed.

Sources:

• Riordan and K
• Wambach
• Breastfeeding and Human Lactation, 4th edition.

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