Inverted nipples do not protrude from the level of the areola but are retracted inwards instead (see image below right of an inverted nipple compared with a normal nipple). Some severely-inverted nipples are fully stuck inwards while others can be drawn out with suction, such as with a breast pump or syringe. Flat nipples are level with the areola.
Nipple preparation (including for mothers with inverted or flat nipples) is unnecessary. 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.
For mothers with inverted or flat nipples, the baby is more likely to attach and feed well if he becomes used to breastfeeding from very early on. It is best to avoid bottles and teats at this time, as these are very different in shape to the 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 can be fully alert, with all inborn reflexes intact, for the first feeds. During the first few days (before the milk comes in) breasts are soft and the baby’s sucking action is strong. 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.
Once 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 be able to draw her nipple out before feeds either manually or with a breast pump. She is likely to know whether touch or applying a cold compress will also help the nipple to stand out more.
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, that many mothers who have difficulties breastfeeding due to anatomical challenges first time around, often find that second or third time around that things are easier.
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), 2012, Breastfeeding Management in Australia. 4th edn. Australian Breastfeeding Association, Melbourne
© Australian Breastfeeding Association March 2013