Breastfeeding with Flat Nipples

12 Tips for Breastfeeding With Flat Nipples

Nipples come in all shapes and sizes. Worried about whether your flat nipples will be okay for breastfeeding. Learn about these 12 tips to make breastfeeding with flat nipples little easier.

No matter how much prepared you feel for your breastfeeding journey, many women struggle to breastfeed their babies.

Although most women are able to breastfeed their babies regardless of nipple shape and size, certain cases require a more work than others.

Among the common breastfeeding problems of why your little one is struggling with breastfeeding could be “flat nipples”, making it challenging for baby to get firm grasp. This may result in baby not getting enough milk because of baby’s poor latch on. Consequently, decrease in milk production and in turn, baby losing interest at the breast.

Worry not, mama! The good news is that with a little extra care and patience, mamas with flat nipples can also breastfeed just fine.

Here’s what you need to know.

What are Flat Nipples?

Flat nipples do not stick outward. They are not distinct from areola and the surrounding skin on your breast. Even when they are exposed to cold temperature or stimulation, flat nipples neither stick outward not turn inward.

Nipples that appear flat most of the time but stick outward when exposed to cold or stimulation are NOT true flat nipples. Some women have nipples that remain flat most of the time, but they often start to stick out during pregnancy.

You may also notice flat nipples when breasts are engorged. Overfilling of with breast milk can make your breast swollen and hard, making it hard for baby to latch on.

Flat nipples do not interfere with breastfeeding most of the time as long as babies take a good portion of breast into their mouth. However, if baby is premature, weak, or having latching difficulty, flat nipples can be especially challenging.

How do I know I have a Flat Nipples?

You can access your nipples to check if you have flat nipples. There are two simple ways to tell if you have flat nipples or not.

Nipple pinch test:

  • Place your thumb and forefinger on the edge of the areola (one inch back from nipple).
  • Compress and thumb and forefinger it lightly.
  • Do this test on both breasts.
  • If the nipple protrudes out, you have normal nipples.
  • If the nipple does not protrude outwards after compression, then you have a flat nipple.
  • If your nipple retracts or become concave when compressed, then you have inverted nipple.

Stimulate your nipples:

You can stimulate your nipples with ice pack or a cold moist cloth. If your nipple does not stick out, then you have a flat nipple.

If you are still not sure, you can consult your health care practitioner. They will do a quick exam of your nipples and let you know if you have a flat nipple or inverted nipple. Regardless of your nipple shape, it does not affect your breast milk production or your ability to dispense it.

If you think your nipples are flat during pregnancy, hormonal changes after birth of your baby may cause it to protrude naturally. So you should take this test during pregnancy and after your baby arrives to check the status of your nipple.

Why are my Nipples so Flat?

The breast is composed of glandular (lobes) and adipose tissue held together by a loose framework of fibers (1). The amount of fatty tissue in your breast and the length of milk ducts determines whether your nipples are flat, normal or inverted.

Flat nipples are fairly common among women. The flat appearance of nipples changes when you become pregnant when skin elasticity changes. Breastfeeding also causes flat nipple to protrude naturally as baby latch on the areolas and drawing nipple out.

There are many causes why your nipple lie flat (2) ,

  • It may be the result of the milk duct (lactiferous ducts) not being grown properly.
  • Abnormally large extra fat tissue causing nipples to retract into them.
  • It could be hereditary

However, having flat nipple is normal, it is always advisable to consult with your family physician to know the cause of flat nipples and rule out any underline medical condition.

Here are 12 tips and tricks to keep in mind if you’re breastfeeding with flat nipples.

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1. Getting a Deep Latch:

Wondering, how do I feed my baby with flat nipples? Simple answer is getting a deep latch!! If baby latches deeply onto the nipple, areola and the breast tissue, flat nipples are not a problem for breastfeeding.

To ensure a good latch, hold baby close and align baby’s nose with your nipple. Bring out nipple by pulling your breast tissue back, rub baby’s lips with your nipple, when your baby’s mouth is wide open, hug your breast onto baby’s mouth.

2. Breastfeeding Hold:

Trying different breastfeeding positions can make it easier for your baby to latch on. Use V-hold or C-hold position to hold your breast and offer areola and nipple to your baby.

Make a V or C shape by compressing your breast with fingers a few centimeters behind your nipple. These holds help support your breast and helps baby to latch deeper onto your breast tissue and feed well.

Some moms swear by laid-back breastfeeding when they have flat or inverted nipple as gravity takes over and overturns the pull of breast tissue so baby can take the breast easier and deeper.

3. Breastfeed Early and Often:

If possible, nurse your baby as soon as possible after delivery and often after that along with skin-to-skin contact. Breastfeeding in the first few days are very important for good breastfeeding relationship. Often feeding soon after delivery will help your baby get comfortable with breast before your milk comes in. Once your milk comes in (3-4 days), breast gets firmer and this can make it harder for baby to latch on with flat or inverted nipple.

4. Getting Help:

Among the most common mistakes that mom makes during breastfeeding is not getting help when needed. When you are dealing with flat or inverted nipple, it is important to make sure that baby is latching on correctly. If you are having trouble getting your baby to latch on, ask for a lactation consultant to evaluate baby’s latch. They will recommend best way to deal with your specific condition.

5. Keep a Track:

If you are breastfeeding with flat nipples, keep a tract of baby’s wet diapers to ensure he/she is getting enough milk. Also, make sure baby is gaining age recommended weight.

Here are the ways to draw your nipple out manually (6-8):

6. Reverse Pressure Softening:

Shortly before breastfeeding, use your fingertips to encircle the base of the nipple and push inward toward chest wall for 1-3 minutes to draw your nipple out for baby to grasp easily (3).

7. Nipple stimulation before Nursing:

Try stimulating your nipple just before nursing by gently rolling it between your thumb and index finger for 1-2 minutes. Then quickly apply moist, cold cloth on your nipple. This will help your nipple to protrude outward. Avoid prolong use of cold cloth on your nipple as it can inhibit let-down.

8. Pull your Beast Manually

Hold your breast with thumb on the top of the breast and four fingers underneath it. Bring out a nipple by slightly pulling on the breast tissue toward chest wall. Express some breast milk onto the nipple to interest baby’s feeding instincts. Once baby opens his mouth wide, aim your nipple toward roof of the baby’s mouth.

If aforementioned tips and tricks do not work for you, use suction devices mentioned below to help with breastfeeding with flat nipples. Research studies (4) have suggested use of shells, cups, shield and nipple extractor to draw out flat or inverted nipple.
This post contains an affiliate links. As an affiliate and Amazon associate, I earn commission on qualified purchase at no extra cost to you.

9. Try a Breast Shell:

Breast shells are worn between feedings. Breast shell has a hole that fits over the nipples. The shell put gentle pressure on breast tissue when worn, to draw nipple out. They are worn 1 hour before nursing. Unlike nipple shield, they are not used during feeding. Prolonged use of breast shells can cause a clogged milk duct or tender spot on the breast so avoid prolonged use of it.

Try this one: Medela SoftShells Breast Shells for Flat or Inverted Nipples

10. Try a Breast Pump

Right before nursing your baby, use a breast pump. The suction of breast pump can help nipple to elongate and protrude out (5). This will help your baby to latch on easily.

Regular use of a pump between feeding session, will help draw out your nipple and increase your milk supply as you and your baby overcome some of the breastfeeding problems.

Try an automatic double electric breast pump, which uses uniform suction to draw the nipple out rather than compressing the areola. Good news is most insurance company covers the cost of it. Here are two brands I trust:

11. Try a Nipple Shield:

 A thin, flexible silicone shield is worn over a nipple during feeding to help draw out a nipple (6). Shield has holes in the center to help milk flow through when baby is sucking. If you are considering on using a nipple shield, consult a lactation consultant, because if not used properly it can result in low milk supply, clogged milk ducts and poor weight gain in baby.

To learn about how to and who should use nipple shield and nipple shield review, refer to this article.

12. Try a Nipple Everter

This little tool is a device with a flange attached to a bulb. It helps to draw out a nipple to help baby latch. Use it just before nursing by placing flange over your nipple. The suction created by squeezing the bulb gently pulls nipple out.

Many moms with flat nipple used Latch Assist Nipple Everter  successfully to draw nipple out before breastfeeding. Check out this video to learn how to use this device correctly.

 Are Flat Nipples a sign of Breast Cancer?

A flat nipple or inverted nipple itself doesn’t mean a sign of cancer. Some women have flat nipple that looks like an inverted nipple or some women develop inverted nipple overtime. Like rest of our body, change in nipple appearance happens overtime and it is considered normal. However, it is important to be familiar with our nipple and any sudden physical changes, sore nipple or newly inverted nipple could warrant a check up with your physician. Breast cancer is often not associated with any nipple changes, but it is important to talk to doctor about it to rule out any underline cause.

Takeaway:

Flat nipple can make breastfeeding little challenging for some mama, but it doesn’t mean that it is impossible. With all the tips and tricks mentioned above, you should have no problem breastfeeding with flat nipples! If you are having trouble with breastfeeding, get all the help you need to make it work. Think about all the benefits it brings to you and your baby. Remember, The first month with newborn is hard and you are doing everything you can to make breastfeeding work, so give yourself a grace. You have got this, mama!!

How About You?

Are you struggling with flat or inverted nipple? What helped your breastfeeding journey?

References:

  1. Tobon H, Salazar H. Ultrastructure of the human mammary gland. II. Postpartum lactogenesis. J Clin Endocrinol Metab 1975;40:834-44.
  2. Zucca-Matthes G, Urban C, Vallejo A. Anatomy of the nipple and breast ducts. Gland Surg. 2016;5(1):32-6. doi:10.3978/j.issn.2227-684X.2015.05.10
  3. Cotterman, K. J. (2004). Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement. Journal of Human Lactation, 20(2), 227–237. https://doi.org/10.1177/0890334404264224
  4. Yukun, L., Ke, G. & Jiaming, S. Aesth Plast Surg (2016) 40: 707. https://doi.org/10.1007/s00266-016-0675-0
  5. Jiang B, Hua J, Wang Y, Fu Y, Zhuang Z, Zhu L. Evaluation of the impact of breast milk expression in early postpartum period on breastfeeding duration: a prospective cohort study. BMC Pregnancy Childbirth. 2015;15:268. doi:10.1186/s12884-015-0698-6
  6. https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1115_dec_21.pdf
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