Inverted or Flat Nipples: Common Breastfeeding Challenges

In pregnancy, lots of mums worry about the size, shape and colour of their nipples and areola. It’s probably the first time we’ve ever thought of these sticking-out bits as having an actual function. And just like women’s body shapes, everyone’s different. Nipples can be long, short, flat, inverted, or even bell-shaped and still nourish and feed a baby. Areolas can be black, brown, pink, as small as a 10-cent piece, large and saucer-like or something in between – there isn’t a better size or colour and the rumour that blondes and redheads with pale nipples will have more nipple damage than mums with dark areolas is a complete furphy! Mostly the function of the areola is to keep the nipples soft and moisturised, as the little bumps on them (the Montgomery tubercles) secrete a lubricating, anti-bacterial substance with a self-cleaning mechanism – how cool is that?

While it’s true that babies will get used to the feel of their own mother’s nipples, there are some nipple shapes that can be more difficult than others when learning to attach bubs to the breast. Inverted and flat nipples are the two most talked-about shape challenges, so here are a couple of tricks I’ve learnt to achieve the best possible latch.

Flat Nipples

If your nipples are quite flat and bubs is sliding around trying to attach to them and getting frustrated, it can help to shape your nipple between your thumb and forefinger and lever the baby’s mouth from underneath the nipple over the top. Pretend the nipple is a hamburger or sandwich that needs to be squashed together to fit into the baby’s mouth and make sure bub’s chin and bottom lip touches the underside of the breast first. If this still doesn’t work, you could talk to your midwife or lactation consultant about trying a nipple shield, which is a Mexican-hat shaped shield made from thin silicone that suctions onto the nipple and helps bubs stay attached. They can be weaned from the shield later when you both get the hang of it.

Inverted Nipples

Truly inverted nipples are quite rare, I reckon I’ve only seen one or two cases of them in the seven years I’ve been helping mums to breastfeed. When you squeeze an inverted nipple, it actually inverts further into the breast. There are lots of nipples, which appear to point inwards, but when baby sucks, or they are attached to a pump, they start to come out. Some of these even start to evert during pregnancy. To help a mum to attach a baby to an inverted nipple, again, the same shaping as for flat nipples should work, and a nipple shield can be helpful if latching isn’t successful on the bare breast. Some mums buy nipple everters, which are like suction caps to squeeze onto the breast before a feed. I haven’t seen these used much in Australia, and I think using the shaping or a nipple shield would be just as effective. Some mums find a few minutes of pumping with a breast pump prior to attaching bubs helps the nipple to come out, or even just softening the aerola with some hand expressing prior to a feed could make the shaping more effective on full breasts.