Nipples vary in shape, size and presentation from woman to woman and, for some women, left to right. Some nipples protrude from the level of the areola (see image below right). Flat nipples are level with the areola. Inverted nipples (see image below left) do not protrude from the level of the areola but are retracted inwards instead. Some severely-inverted nipples are fully stuck inwards while others can be drawn out with suction, such as with a breast pump or syringe.
Nipple preparation (including for mothers with inverted or flat nipples) is not needed. All nipples tend to become more supple during pregnancy, so there is no need to be too concerned before pregnancy or in the early stages of establishing breastfeeding. It is worth noting that babies do not nipple feed but breastfeed. Referring to the Breastfeeding plan article on this website can help get breastfeeding off to the best start possible.
For mothers with inverted or flat nipples, the baby is more likely to attach and feed well if they become used to breastfeeding from very early on. It helps to avoid bottle teats and dummies soon after birth, as these are very different in shape to an inverted or flat nipple. If supplements are medically required, a cup or syringe may be better choices. If possible, avoid medications during labour so the baby is more likely to be born fully alert, with their inborn feeding-related reflexes intact, for the first feeds. During the first few days (when colostrum is being made, before the breastmilk comes in) the mother's breasts are soft which can make it easier for some babies to attach. If the breasts become full or engorged, the baby may find it harder to attach. A little hand expressing or reverse pressure softening can help to soften the area around the nipple making it easier for the baby to attach.
A mother may find helpful to try to draw out a flat or inverted nipple before feeds either manually or with a breast pump. Another strategy that some mothers find helps the nipple to stand out more is touch or application of a cold compress. The success rate varies from mother to mother and she will soon work out whether this works for her.
If a baby continues to have ongoing problems with attachment once a mother’s milk has come in, a nipple shield may be helpful.
Rest assured, many mothers who have difficulties breastfeeding due to anatomical challenges first time around often find that things are easier the second or third time around.
As one mother said: "My advice for women with inverted nipples is that you can breastfeed your kids. I won’t say it will be easy, but with the right support, information and equipment, you can do it and it will be worth every minute".
Brodribb W (ed), 2019, Breastfeeding Management in Australia. 5th edn. Australian Breastfeeding Association, Melbourne.
Breastfeeding: Breast and Nipple Care tells you what to expect as your breasts change during pregnancy and briefly covers how breastfeeding works. It also has information about common breast and nipple problems, how to treat these problems and ways you can prevent them.
© Australian Breastfeeding Association December 2019