Flat or Inverted Nipples

Nipples come in all sorts of sizes and shapes. Some nipples tend to stay pretty flat or even disappear inward when touched.

It is generally thought adhesions (tight pieces of tissue) keep the nipple from protruding. This is often accentuated when your milk production increases, since your breast fills with milk and all of the skin on your breast stretches tighter.

This means your baby has to learn how to pull the nipple out and far enough into his mouth to efficiently get your milk. It is rare that a baby cannot learn this extra step, but ?

it does take extra patience on your part (and on the baby's part!) to get through the learning process. Be patient, and keep trying.

The use of a bottle at this time may lessen your baby's interest in breastfeeding. (Just the opposite of what you want!) A baby sucks on an artificial nipple differently than the breast, so he may be confused and actually push your breast out after being fed from a bottle. If supplementation is needed, your pumped breast milk given with an eye dropper, syringe, cup or even a spoon are the better choices.

Watch how your baby is doing overall. If your baby is not having 6-8 wet diapers a day and one or more breastfed stools (consistency of mustard and cottage cheese) after your milk comes in, call a lactation consultant or your pediatrician for help and a weight check for your baby.

Recommendations
1. Try Hoffman's Maneuver: This is a gentle stretching exercise whereby you pull the skin back and away from the nipple with your fingertips. (See picture).

2. Wear breast shells. Worn directly on the nipple, shells exert gentle pressure around the nipple encouraging it to stand out, erect and ready for your baby. Shells are worn inside your bra, night and day, (or as much as you can), until the problem is resolved. Research on shells is mixed, some studies say they have the desired effect, others showing no effect. But it won't hurt to try them.

3. Try gentle nipple rolling prior to latching your baby onto the breast.

4. Pump with a cycling electric or manual pump for a few minutes prior to latching your baby on. This will help pull the nipple out, soften the area around the areola if you are engorged, and stimulate a letdown so the milk is easier for the baby to get.

A cycling electric pump also serves the purpose of increasing and/or maintaining your milk supply while your baby is learning to latch and suck effectively.

5. In some cases, use of a nipple shield can help pull the nipple out as well as giving the baby something firmer to grasp onto. A nipple shield is a thin piece of silicone placed over your nipple while you nurse your baby. Using a nipple shield may reduce your supply of milk, so it is important to use a nipple shield only with the counsel of a lactation consultant or your health care provider.