Breasts and nipples have as much diversity in shape and size as our other body parts. The range of normal is wide. Most of us don’t look like the pictures in the breastfeeding books or videos. You may notice that your breasts are not exactly the same size. Each nipple may be different. Some nipples stand out. Some look flat. Others look like they are poking inward.
The most important thing to remember is that babies BREASTfeed not NIPPLEfeed. As long as your baby can get a good portion of the breast in his mouth, then most types of nipples do not cause problems. When your baby latches well, his lower lip is well back from the base of the nipple. Much of the darker area, or areola, will be in his mouth. Areolas can be small or very large. Your baby doesn’t have to take the whole areola in his mouth. He just needs enough of it so that he is getting a good, deep latch.
You can confirm that you have a flat or inverted nipple by doing a “pinch” test. Gently compress the areola about an inch behind the nipple. If the nipple doesn’t become erect, then it is considered to be flat. If the nipple retreats or dimples inwards then it is inverted. In the early days of breastfeeding nipples can look flat due to engorgement (breast fullness). Truly flat or inverted nipples never become erect when stimulated or exposed to cold. Breastfeeding a baby can change an inverted nipple permanently or temporarily.
For some parents, flat or inverted nipples can make breastfeeding difficult at first. With coaching and patience, these challenges can be resolved and breastfeeding established. Until your baby is latching and feeding well, you will need to express your milk. Frequent milk removal by hand or with a pump will maintain milk production. Then there will be plenty of milk available when your baby latches.
Some types of inverted and dimpled nipples can cause pain as the tissue that holds the nipple stretches. This may last a couple of weeks or longer while your baby’s sucking gradually draws out your nipple. If the tissue remains tight and does not stretch easily, the nipple may be compressed in your baby’s mouth. This often causes damage to the end of the nipple. It may be necessary to pump or hand express your milk until your nipple is drawn out enough for your baby to latch comfortably. You can feed the expressed milk to your baby by spoon or cup. See How to Protect Breastfeeding while Supplementing.
Your nipple may pull in after nursing, creating a dimpled area in the middle. It is important to dry the area before the nipple pulls in. If milk is left to pool inside the dimple, it can cause the skin to break down. This is painful and may become infected. The nipple can be dried with a clean cloth or hair dryer set on warm.
If you have inverted nipples, it is important to get good support early on.
- Try the laid-back feeding position. See Positioning and Latching.
- Ensure you have a good, deep latch.
- Hold your baby skin-to-skin. See Skin-to-Skin Care.
- Feed your baby early and often. See Establishing Your Milk Supply.
- Avoid giving your baby an artificial nipple, if possible, until latching is well-established. If you need to supplement your baby, consider a cup or a spoon. See How to Protect Breastfeeding while Supplementing.
Try these techniques to draw out an inverted nipple and help your baby latch:
- Pull back slightly on your breast tissue to help your nipple stick out.
- Roll the tissue behind your nipple between your thumb and finger for a minute or so. Then quickly touch it with a cool, moist cloth for a few seconds.
- Make a “breast sandwich” by gently compressing the breast between your thumb and fingers. Bring your baby to your breast and help your baby to take a big mouthful of “sandwich”. Keep your fingers well back on the breast so that they do not get in the way of your baby’s chin.
- Use the “nipple tilt” technique to help your baby get a deeper latch. See Positioning and Latching.
Between feedings try these techniques:
- Wear breast shells in your bra before feedings. The back of the shell has a hole for your nipple. It puts pressure on the areola or dark area around the nipple. This helps the nipple poke out. Do not use the breast shells for more than 30 minutes before a feeding. Wearing them for extended periods of time can lead to mastitis. Wear a bra large enough to hold the breast shells comfortably.
- Use a breast pump for a minute or so before feeding. This draws the nipple out. It also softens the breast slightly by removing some milk. A softer breast may be easier for your baby to latch. Do not remove too much milk or your baby may be frustrated by the lack of milk in your breast.
- Use a modified 20ml syringe to help draw out the nipple. Cut the tip off of a syringe using a sharp knife. Place the plunger in the opposite/uncut end of the syringe. Place the modified syringe over the nipple. Gently pull the plunger out to draw out the nipple. Do this for 30 to 60 seconds several times a day.
- Use a commercially available “nipple everter”. These specifically designed products can be placed over the nipple to draw out the nipple. Follow the manufacturer's instructions.
- Use a nipple shield if your baby is unable to latch. Make sure your baby is feeding on the breast, not the tip of the shield. If you are not sure your baby has a deep latch, ask a La Leche League Leader or International Board Certified Lactation Consultant (IBCLC) to observe a feeding.
With good information and support most babies are able to latch well onto a flat or inverted nipple.
If you think you have flat or inverted nipples, it can be helpful to talk to a La Leche League Leader before your baby is born to get some tips to smooth out the first few days. If you are struggling with sore nipples or getting your baby to latch well, get help right away.
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Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc., 736-740.