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Breastfeeding with flat nipples.

Posted by on Sep. 14, 2011 at 6:16 PM
  • 10 Replies

My nipples arent very raised at all. I have been trying to watch videos on proper latching and every video i see has long nipples. Will my flatter nipples cause problems? I tried breastfeeding with my son and we had major issues and i gave up. Im just looking for as much help and info i possibly can to succeed this time. I want that bonding expierence with atleast one of my kids.

by on Sep. 14, 2011 at 6:16 PM
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by on Sep. 14, 2011 at 6:21 PM

go to BRU and get Nipple SHELLS, not nipple shields (theyll have both) wear them off and on during the last month of your pregnancy and that should help alot, it has for me. I only occasionally use them before a feeding but my nipples are flat and inverted and with the shells ive not had any problems this time with them affecting latch.

by on Sep. 14, 2011 at 7:06 PM

I have very flat nipples (even after nursing two kids for almost five years total).  With my first I wasn't prepared and used shields.  After he gained a pound in the first 10 days after birth I decided to wean him off the shields.  Shields are messy and a PITA. 

I would let him latch with the shield and suckle for a minute.  That was enough time to elongate the nipple and not get him too full so that he wasn't interested in nursing.  Then I popped him off and got him latched.  It wasn't easy and he protested plenty but we were off the shields during the day by 2 weeks.  Off at night took a bit longer because I didn't want to make him struggle (read - wake fully and we ALL lose sleep).

I was surprised when my daughter had similar issues.  After all, I had nursed her big bro for 34 months and had only quit two months before she was born. 

Find a GOOD LC or, better yet, an IBCLC.  Or get ahold of your local LLL.  If you have flat/inverted nipples you need experienced help. 

by Group Admin - Amy on Sep. 14, 2011 at 7:07 PM

Yes, wear nipple shells in your bra.  They will help draw them out.

by on Sep. 14, 2011 at 7:15 PM

i have the same problem, but my oldest still latched fine. after this last pregnancy and breastfeeding they are more 'normal' now.


by on Sep. 15, 2011 at 12:07 AM
Since I have been pregnant, hubby said they look longer than usual. I'm hoping that I have great success
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by on Sep. 15, 2011 at 12:09 AM

nipple shells for sure! I kept mine on throughout the day. It helps! And your laction consultant can give you one for free.

by on Sep. 15, 2011 at 1:07 AM

Nipple shells for sure and before nursing, take your fingers and pull and roll em a little to give baby something to latch on to, baby will draw the rest in : )

by on Sep. 15, 2011 at 1:24 AM

My doctor said I have inverted or flat nipples. Can I still breastfeed my baby?

Remember that babies BREASTfeed, not NIPPLEfeed. As long as baby can take a good portion of the breast into his mouth (baby's mouth and gums should bypass the nipple entirely and latch on to the areola), most types of flat or inverted nipples will not cause problems with breastfeeding. Some types of nipples are more difficult for baby to latch on to at first, but in most cases, careful attention to latch and positioning, along with a little patience, will ensure that baby and mother get off to a good start with breastfeeding.

How can I tell if my nipples are flat or inverted?

Just looking at the breast often won't tell you the answer. Instead, you can determine whether or not your nipples are flat or inverted by doing a "pinch" test. Gently compress your areola (the dark area around the nipple) about an inch behind your nipple. If the nipple does not become erect, then it is considered to be flat. If the nipple retracts, or becomes concave, it is considered to be inverted. It should be noted, too, that true inverted or flat nipples will not become erect when stimulated or exposed to cold. If the nipple becomes erect during the "pinch" test, it is not truly inverted and does not need any special treatment.

Different Types of Inverted and Flat Nipples

  • Dimpled:
    Only part of the nipple protrudes. The nipple can be pulled out but does not stay that way.

  • Unilateral:
    Only one breast has an inverted or flat nipple

  • Inverted:
    There are different possible degrees of nipple inversion. The lesser degree of inversion is classified as slight. A baby with a normal suck will likely have no problems with bringing a slightly inverted nipple out, although a premature baby or one with a weak suck might have difficulty at first. Moderate to severe inversion means that the nipple retracts deeply when the areola is compressed, to a level even with or underneath the areola. A nipple with moderate to severe inversion might make latching-on and breastfeeding difficult, but treatment and deep latch techniques can help. Treatment to stretch out the nipple might be helpful, especially during pregnancy. If the inverted nipple is only discovered after birth, treatment will still be useful, but good positioning and latch-on are most important.

Treatments For Flat Or Inverted Nipples, and Techniques To Make Latching Easier

Although opinions and experiences vary, many women have found treatments for inverted or flat nipples helpful and many breastfeeding experts continue to recommend them. Breastfeeding experts disagree on whether pregnant women should be screened for flat or inverted nipples and whether treatments to draw out the nipple should be routinely recommended. For example, the British Royal College of Midwives says that hormonal changes during pregnancy and childbirth cause many mothers' nipples to protrude naturally. Although treating flat and inverted nipples during pregnancy is debated, if your newborn is having difficulty latching on to a flat or inverted nipple you may find some or all of the following helpful.

  • Breast shells
    Worn inside your bra, breast shells may help draw out flat or inverted nipples. Breast shells are in two pieces and are made out of plastic. The inner piece has a hole that fits over the nipple. The pressure on the tissue around the nipple causes the nipple itself to protrude through the hole. Breast shells may be worn during pregnancy to take advantage of the natural increase of the elasticity of a woman's skin by applying gentle but steady pressure to stretch the underlying adhesions (connective tissue) and draw out the nipple. After birth, they can be worn for about a half an hour before feedings to draw out the nipple. They should not be worn at night, and the milk collected while wearing them should not be saved.

  • Hoffman Technique
    This procedure may help loosen the adhesions at the base of the nipple, and can be used during pregnancy as well as after the birth. Place a thumb on each side of the base of the nipple -- directly at the base of the nipple, not at the edge of the areola. Push in firmly against your breast tissue while at the same time pulling your thumbs away from each other. This will stretch out the nipple and loosen the tightness at the base of the nipple, which will make it move up and outward. Repeat this exercise twice a day, working up to five times a day, moving the thumbs around the base of the nipple.

  • Breast Pump
    After birth, an effective breastpump (See How Do I Choose a Breast Pump? for more information on pumps) can be used to draw out the nipple immediately before breastfeeding. This makes latching easier for baby. A pump can also be used at other times after birth to further break the adhesions under the nipple by applying uniform pressure from the center of the nipple.

  • Evert-it™ Nipple Enhancer
    Designed by lactation consultants, the Evert-It™ consists of a syringe with a soft, flexible tip made of silicone, either end of which may be used to provide suction to help nipples protrude for easier latch-on. Use it before feedings as you would a breast pump.

  • Nipple stimulation before feedings
    If the nipple can be grasped, roll the nipple between the thumb and index finger for a minute or two. Afterwards, quickly touch it with a moist, cold cloth or with ice that has been wrapped in a cloth. This method can help the nipple become erect. Avoid prolonged use of ice, as numbing the nipple and areola could inhibit the let-down reflex.

  • Pulling back on the breast tissue during latch-on
    As your hand supports the breast for latch-on with thumb on top and four fingers underneath and behind the areola, pull slightly back on the breast tissue toward the chest wall to help the nipple protrude.

  • Nipple shield
    A nipple shield is a thin, flexible silicone nipple that is worn over the mother's own nipple. It has holes in the tip to allow milk to flow to the baby. If other strategies are not working, a nipple shield could help baby latch on and nurse well by providing the stimulation to the roof of the baby's mouth that signals his suck reflex. Nipple shields should only be used with the guidance of a lactation professional as they can lead to problems if not used properly.

Getting breastfeeding off to a good start

  • Get help with positioning and latch-on
    Getting skilled help is critical for a mother with inverted or flat nipples. It is important for the baby to learn how to open his mouth wide and bypass the nipple, allowing his gums to close further back on the breast. Experimenting with different positions is a good way to find what is most comfortable for the mother and helps baby latch most effectively. Some mothers find that the football (clutch) hold or cross-cradle hold gives them the most control, which also makes it easier for baby to latch on well.

  • Breastfeed early and often
    Plan to breastfeed as soon after birth as possible, and at least every 2-3 hours thereafter. This will help you avoid engorgement, and will allow baby to practice at breastfeeding before the milk becomes more plentiful or "comes in". Lots of practice at breastfeeding while mother's breasts are still soft often helps baby to continue to nurse well, even as the breasts become more firm (which can make a flat nipple more difficult to grasp).

  • Achieve a deep latch
    When latching your baby on, hold him in close against your body, with his ear, shoulder, and hip in a straight line. Align baby's nose with your nipple. Pull back on your breast tissue to make it easier for him to latch on. Tickle baby's lips with nipple and wait for baby to open wide (like a yawn). Then latch him on, assuring that baby has bypassed the nipple and is far back on the areola. The resulting latch should be off-center -- deeper on the bottom (more breast taken in on the chin side than the nose side). Baby's nose should be touching (but not buried in) the breast, and his lips should be flared out like "fish lips".

  • Use calming techniques if baby becomes upset
    Baby should not associate breastfeeding with unpleasantness. If baby becomes upset, immediately take a break and calm him. Offer a finger for him to suck on, walk, swaddle, rock, or sing to him. Wait until he is calm before trying again.

If nipple soreness occurs

  • Discomfort as adhesions stretch
    Some mothers experience nipple soreness for about the first two weeks of nursing as their flat or inverted nipple(s) are gradually drawn out by baby's suckling. If the soreness is severe, or continues past the initial two weeks, call your local LLL Leader or IBCLC for assistance. You may also find relief by using these treatments for sore nipples.

  • Moisture becoming trapped as nipple inverts after feeding
    If the nipple retracts after feedings, that skin may remain moist, leading to chapping of the skin. After feeding, pat your nipples dry and apply Lansinoh™ brand lanolin (or other 100% lanolin preparation for nursing mothers). You may also wish to use a Velcro Dimple Ring, which is a device designed to hold the nipple out between feedings so that the skin can dry. Call your local LLL Leader or IBCLC for information on the use of this product, and where to obtain it.

by on Sep. 15, 2011 at 2:31 AM

 my nipples got flat during my first pregnancy as my breast changed. i was given nipple SHELLS and that helped they make you leak alot though. after a few weeks i no longer needed them cuz as time goes on your nipples dont get flat anymore from baby sucking them out soo much

by on Sep. 15, 2011 at 10:50 AM

Thanks ladies. I'll definitely look into the breast shells

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