Anybody who has Googled “Why won’t my baby latch?” will find “inverted nipples” somewhere on the long list of reasons why your little one could be struggling with breastfeeding. But don’t assume inverted nipples are at the root of the problem until you’ve fully understood what they are—especially because many women have no issue breastfeeding with inverted nipples.
Here we’ll review:
what inverted nipples are
how to determine if you have inverted nipples
and tips and tricks for breastfeeding if you have inverted nipples
What Are Inverted Nipples?
An inverted nipple is when the nipple is retracted into the tissue of the breast, instead of pointing outward.
When nipples are inverted, they look more like a dimple on the breast rather than a protruding cylinder shape. This can occur on one or both breasts.
There are varying degrees of nipple inversion—in minor cases the nipple may only be slightly inverted and can be pulled out with fingers. In more severe cases, the nipple retracts deeply into the areola causing a dimple.
Regardless of degree of inversion, true inverted nipples will not become erect even when stimulated or cold. (source)
Inverted nipples are perfectly natural—they say nothing about your health and are not cause for concern unless they occur later in life. Approximately 10 to 20 percent of women have flat or inverted nipples. (And men can have them too!)
How to Tell If You Have Inverted Nipples
If your nipple protrudes at all—naturally or when stimulated by touch or temperature—you do not have an inverted nipple.
If you’re unsure, there is a simple do-it-yourself test called the Pinch Test.
Hold your breast at the edge of the areola between your thumb and index finger.
Press in about an inch behind your nipple and stroke your two fingers forward.
If your nipple protrudes, you don’t have an inverted nipple. If it does not protrude or become erect, it is considered flat. If it retracts or disappears, it is considered an inverted nipple. (source)
Remember to do this test on both nipples, since each breast is different and some women may have just one inverted nipple.
What Does an Inverted Nipple Mean for Breastfeeding?
An inverted nipple is definitely not a deal breaker for a breastfeeding mama.
“Remember that babies BREASTfeed, not NIPPLEfeed” — La Leche League
When breastfeeding, baby should open up wide enough that he/she takes a good portion of the breast into his/her mouth, bypassing the nipple entirely. Because of this, in most cases, inverted nipples alone will not cause problems with breastfeeding.
When Inverted Nipples May Interfere With Breastfeeding
That said, inverted nipples can make it more difficult for some women to breastfeed. In rare cases, a mother can experience persistent sore nipples because the baby compresses the buried nipple rather than compressing the milk ducts. The result is little milk for baby, and a painful experience for mother.
Breastfeeding is more likely to be a challenge for women with inverted nipples based on:
Degree of inversion: If mama has a slight inversion—the most moderate case—a baby with a normal suck is unlikely to have a problem feeding. If mama has moderate to severe inversion—when the nipple retracts deeply into the areola—baby may have more trouble compressing the milk ducts. The good news is that breastfeeding is usually possible, no matter how inverted the nipples are. Consult a lactation consultant for help establishing a proper latch and have patience with yourself and baby.
Other latching issues: When combined with other latching issues, like tongue tie or lip tie, mama and baby are much more likely to have problems with breastfeeding.
Surgery for Inverted Nipple
In some extreme cases, women may opt for surgery, though it is risky. Even surgery intended to preserve milk ducts can interfere with some or all milk production.
For mamas who opt for surgery but intend to breastfeed, doctors may use the Parachute Flap Technique. Here’s what to expect:
Your doctor will apply a local anesthetic, then wait a few minutes.
He/she will then make an incision around the base of your nipple, then lift the nipple and the areola from the breast.
He/she will then sew the tissue into a protruding shape, before closing the incision with stitches and applying medicated gauze.
Though the surgery is considered safe and effective, it can reduce the size of the areola and result in a nipple that is too large. Since most breastfeeding moms can nurse successfully with inverted nipples, it’s best to start with all of the natural, non-invasive methods below.
Natural Treatment for Inverted Nipples
Since surgery for inverted nipples can actually hinder milk production and inverted nipples alone don’t usually cause breastfeeding issues, many experts do not recommend screening and treatment for inverted nipples. Instead, they recommend manual stimulation to temporarily draw out the inversion. Here are the most common options:
The Hoffman Technique
The most common manual treatment for inverted nipples is the Hoffman Technique, but it’s important to note that studies show conflicting evidence as to whether or not this technique works—and for how long. (source/source)
Here’s how to try it yourself:
Place your thumbs at the base of either side of your nipple and press firmly into your breast tissue.
While pressing down, pull your thumbs away from each other.
Move your thumbs all around the nipple and repeat.
Repeat once per day.
Studies support the use of suction devices—shells, cups, and nipple extractors—for drawing out inverted nipples. They are worn for longer periods of time (over the course of the day, for example), and are meant to loosen the nipple tissue to help nipples stay erect for longer periods of time.
The nipple retractor technique is a feasible, effective, and safe method for correction of grade I and grade II nipple inversions, and could also be indicated for primary correction of grade III inversion. Its most significant advantage is that lactiferous duct injury can be avoided and the breast feeding function preserved.
Try an automatic double electric breast pump, which uses uniform suction from the center of the nipple to draw it out rather than compressing the areola. Over time, the suction usually works to break the adhesions that are holding the nipple in. Here are two brands to try:
A nipple shield—a thin, flexible silicone shield that’s shaped like a nipple and has holes in the tip to allow milk to flow to the baby—can also help. These devices are used during feedings to help draw the nipple out. (Consult a lactation consultant before attempting to use the shield, as it can frustrate the baby and lead to further problems if not used correctly.) Try this one: NUK Barely There Nipple Shield
Breast shells are another wearable item that can assist nipple profusion, but unlike the shield, are not used during feeding. Instead, they are worn inside your bra for about an hour before feedings to draw out the nipple. Try this one: Beyoyo Breast Shells
More Tips and Tricks for Breastfeeding With Inverted Nipples
There are clear disadvantages to surgery and sometimes even the natural treatments outlined above aren’t as effective as you may like. But there are quite a few tips and tricks you can still try if you’re struggling with breastfeeding because of your inverted nipples:
Regular nipple stimulation: Before feedings, roll your nipple between your thumb and index finger for 1-2 minutes. Follow up with a damp cold cloth or with ice that has been wrapped in cloth. Keep in mind, you don’t want to ice the nipple to numbness as this can inhibit your let-down reflex.
Manually pulling back breast tissue: As baby goes to latch, place your thumb on top of your areola and your other four fingers underneath it. Pull the breast tissue towards the chest to help the nipple protrude.
Reverse pressure softening: Before baby latches, place all five fingers around the base of the nipple. Push towards the chest for 1-3 minutes. This may help the nipple protrude and trigger milk flow.
Ensure baby gets a deep latch. When baby is latching, hold him/her close and align baby’s nose with your nipple. Pull your breast tissue back, tickle baby’s lips with your nipple, and wait for baby to open wide. (Check out these breastfeeding positions for help getting a better latch.)
Get help. A certified lactation consultant can help. You can also attend La Leche League or Breastfeeding USA Meetings. These are free of charge and is a place for breastfeeding support. Reach out sooner rather than later to avoid unnecessary stress and frustration for both mama and baby.
Nipple inversion can make breastfeeding more challenging for some mamas, but it doesn’t make it impossible. If you’re having trouble, give yourself some grace—breastfeeding is hard! If you can get help and stick with it, the benefits are great. But occasionally, breastfeeding becomes too much stress for you or baby, and it just doesn’t work out. If that’s the case for you, forgive yourself and know that there are plenty of great natural formulas options, too.
How About You?
Are you struggling with flat or inverted nipples? What helped your breastfeeding journey?
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