Flat nipples can cause problems with breastfeeding. I never knew that so many women have or had this issue. I have also helped many women to breastfeed who never thought they would have had such an opportunity. Flat nipples are a problem for many new moms.
Most women (90%) have what are known as common nipples, which are those that protrude at rest and, because they’re loaded with nerve endings, become erect due to stimuli like cold, touch, and sexual activity. The remaining 10% of women have flat or inverted nipples (paid link).
Did you know that there are even differences among these nipple types. Yes differences in their positions; as some face front, while others point sideways. Many women have a mismatched pair—for instance, maybe one nipple is higher than the other, or only one is inverted or flat.
Knowing this may come as a relief if you are concerned that your nipples are not “normal.” That said, there are some nipple differences that signal a potential problem, and they, too, are worth learning more about.
About 1% to 5% of people have an extra nipple or nipples, which are known as supernumerary nipples. These extra nipples don’t cause any problems, though they may lactate if you breastfeed. I have seen this about three times during my practice.
The Normal Nipple:
This type of nipple is the normal nipple where it protrudes out from the areola and baby is able to latch on easily.
Inverted nipples are those that are drawn and does not protrude like a normal breast. Nipple inversion is an hereditary condition, meaning a condition you’re born with. They respond to cold or arousal. The inverted nipples looks like a a slit or a fold and should be graded by function, not appearance.
It usually occurs when breast tissue adheres tightly to the base of the nipple, enough to prevent it from sticking out, or due to shortening of the milk ducts themselves, which pass through the breast and open into the top of the nipples. There are 3 different grades of inverted nipples:
These are easily pulled out by baby sucking or a breast pump
This type is easily pulled out while baby is sucking or you are pumping, but does not sustain the protrusion once you are not pumping or baby is not breastfeeding.
These ones are difficult or impossible to pull out. (Flat). Grades 1 and 2 nipples become everted overtime with breastfeeding, hand expression, or pumping. You can also milk express as an adjunct to breastfeeding.
With grade 3 nipples, there is the risk of poor milk production and failure to thrive. Mothers who are trying breast shields must observe their babies for signs of not having sufficient calories.
Signs that baby is calorically deprived:
- The baby sleeps more and acts satisfied when he needs to feed.
- Watch baby’s diaper changes:
In mild cases, the nipples are occasionally inverted, but will spontaneously become erect with stimulation. In more severe cases, the nipple cannot be made to protrude manually.
If you’ve had them all your life, inverted nipples are usually harmless, though they can sometimes make breastfeeding more difficult.
However, if they occur later in life or are a change from your normal protruding nipples (known as acquired nipple retraction), they can sometimes be a sign of a medical condition and should be checked out by your doctor.
Nipple sensitivity varies from person to person, but inverted nipples should be as sensitive as nipples (paid link), that point outward.
Some women find the appearance of inverted nipples very distressing. There are several options for reversing the direction of these nipples.
For mild inversion, various devices for self-retraction and vacuum approaches have been used. The results of these treatments, however, are usually modest at best and are not usually a long-term solution.
What Can Be Done?
Breast shells are useful tools for this problem
Breast shells are very helpful temporary tools for women who have:
- or leaky breasts
They are made up of two silicone or plastic parts that are worn over the breasts. You place the round bottom ring over your areola allowing your nipple to stick through a hole in the center. This piece puts a gentle pressure at the base of your nipple. It shouldn’t be painful. A second dome-shaped piece fits over the bottom ring to protect your nipple and collect any breast milk that may leak from your breasts while you’re wearing the breast shells.
- Breast shells are worn to help correct flat nipples, retracted nipples, or inverted nipples. If you wear breast shells between feedings, they may help to draw out your nipples and make it easier for your baby to latch on well.
- Breast shells can protect sore, cracked nipples from rubbing up against your nursing bra or breastfeeding clothes. Since they help to prevent further pain and irritation, your nipples may heal more quickly.
- Wearing breast shells can relieve mild breast engorgement. They put slight, constant pressure on the nipple and that lets some of the breast milk drain slowly out of your breasts and into the outer shell.
- Since breast shells can collect breast milk, they can prevent embarrassing leaks and protect your clothing from stains.
- Breast shells can be worn to collect the dripping breast milk from one breast while you breastfeed or pump on the other breast.
- You should not be wearing breast shells because they can cause premature labor because they stimulate the breasts.
Plastic surgery can be done to reverse inverted nipples. A number of different procedures have been used. If you’re considering this, find a plastic surgeon who has experience in treating nipple inversion.
Ask if you can see any before and after pictures of other women who’ve had the procedure done. You may want to get a second opinion as well.
Flat Nipples: Little or No response to stimulation
Flat nipples are not raised. They appear to lay even with the areola, the ring of pigmented skin surrounding the nipple, and the skin on the rest of your breast. They don’t respond to cold or arousal.
Many women have nipples that appear flat most of the time, but then become erect when they’re exposed to cold temperature or sexual stimulation. These are not truly flat nipples.
Women with flat nipples who plan to breastfeed should not have any issues, as their nipples will likely protrude outward during pregnancy. If women with flat nipples don’t like how they look, they can try the same remedies that are used to reverse inverted nipples.
- You can wear a product called breast shells between feedings.2 Breast shells put pressure on the base of your nipple to help them stick out more. Just remember to remove the breast shells before you breastfeed your child.
- Unlike nipple shields, you cannot wear breast shells while you’re nursing.
- Try using a breast pump right before you nurse your baby. The suction of a breast pump can help to draw out and elongate your nipples.3 There is also something called a nipple averter that can help pull out flat nipples.
- If your nipples are flat due to breast engorgement, you can try to remove a little bit of breast milk before you put your baby to the breast.
- Hand expressing or pumping some breast milk before feeding helps to soften engorged breasts and makes it easier for your baby to latchon.3 However, you should only pump a little bit of breast milk.
- Remember that when you remove too much breast milk, your body will make more and engorgement could get worse.
- Use a V-hold or a C-hold to gently squeeze your breast and present your nipple and areola to your baby. These holds compress the breast like a sandwich so the baby has something to latch on to.
- Learning how to hold and offer your breast to your baby can help to encourage a good latch.
- If you are having trouble getting your baby to latch on, or if you’re not sure if your baby is latching on correctly, have your baby’s latch evaluated by your doctor or a breastfeeding specialist.
- A trusted health professional with breastfeeding experience can recommend the best ways to deal with your specific circumstances.
- To be sure that your baby is breastfeeding well on your flat nipples, look for the signs that he or she is getting enough breast milk.
- (paid link) Keep track of your baby’s wet diapers and be sure to take your baby to all her scheduled well-visits for weight checks.
What Can Be Done?
Nipple Shields (paid link) are great-Seek the assistance of a breast professional for guidance and sizing; it is only a temporary use and can reduce your milk supply.
As baby latches, the nipples can be stretched to accommodate a good latch and discontinued after latching on is established.
Wearing a nipple shield while breastfeeding is helpful for women having problems with their babies latching on. Unlike the shell, it is used while breastfeeding. They come in assorted sizes and are of different brands.
There are hair follicles surrounding your nipples, so it’s normal to have at least a little hair around them. And yes, it’s safe to remove unwanted hair by tweezing, waxing, shaving, or getting laser treatments.
That said, if the hair growth is excessive, you’re also experiencing hair growth in other areas (for instance, on your face), or you also have other symptoms like irregular periods, acne, and obesity, see your doctor.
These can be signs of an underlying problem like polycystic ovary syndrome (PCOS), a common medical condition caused by hormonal imbalance,7 or Cushing’s syndrome, a disorder that occurs when the body is exposed to too much of the stress hormone cortisol.
If you have any concerns about your nipples or if you are having difficulty latching your baby on to your breast seek help as soon as possible.
A lactation consultant, your doctor, your baby’s doctor, or a local breastfeeding group can provide assistance (paid link).
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We have come to the end of our session of nipple variations. If you are a woman with flat or inverted nipples, I hope you are still able to breastfeed using the suggestions here.
Make sure to get some expert advice from your breastfeeding professional to ensure that you a doing the right thing for your situation. Thank you for stopping by . I hope you succeed in your breastfeeding journey. You can leave your email address below.
I would love to hear from you. If you have comments or questions, I will be happy to answer them below.
Here is a great video for you to watch as you learn more. Enjoy!
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