Many women worry that their breasts and/or nipples are not the right size or shape for breastfeeding. Actually, your ability to breastfeed has little to do with the size and shape of your breasts. Breast shape is seldom significant, and nipple shape poses a problem for only a small number of women. As long as your baby is able to take in a mouthful of breast, even flat or inverted nipples will not interfere with breastfeeding, and your baby’s strong suck will likely draw out the nipple.
It may be a little more difficult for women with inverted nipples to get their baby to latch onto the breast well, but with preparation and knowledge, most women with flat or inverted nipples will experience few problems with breastfeeding.
To find out if you have flat or inverted nipples, you can try the “Pinch Test.” Here’s how:
- Place your thumb and first finger on the areola about 1-2 inches from the base of the nipple.
- Press your thumb and finger together.
- If your nipple does not protrude or extend out, it is considered flat.
- If your nipple retracts or sinks in, it is considered inverted. Truly inverted nipples are rare.
Another sign of flat or inverted nipples is no movement of the nipple when stimulated or in response to cold. If your nipples protrude (extend out) when stimulated, they shouldn’t pose a problem when breastfeeding.
Suggestions for drawing out a flattened or inverted nipple:
- Use a breast pump to gently draw out the nipple and to make it easier for your baby to latch on. Most nipples will extend out with only a minute or two of pumping. Once you see the nipple lengthen, remove the pump, and quickly place your baby on your breast.
- Keep your breasts from getting engorged. It is harder to draw out a flat or inverted nipple when your breast is overly full. To keep your breasts from becoming engorged, be sure to breastfeed at least 8 times in each 24-hour period.
- Pay particular attention to your baby’s position and latch. Your baby’s mouth should be opened wide and filled with breast tissue. When your baby is positioned well, your nipple will be at the back of your baby’s mouth, near the junction of the hard and soft palate.
- Some women choose to wear breast shells (plastic, circular, dome-shaped devices with an opening in the back that you place over your nipple) during pregnancy to slowly cause a flat or inverted nipple to extend out. However, research shows that breast shells are seldom helpful and may, in fact, do more harm than good by making mothers all the more anxious. It may be worthwhile to wait until after your baby’s birth to see if there is a problem with breastfeeding before exploring this option.
- Consider using a nipple shield (a circular device with a pin-holed nub that allows for the flow of breast milk) to aid attachment, support milk transfer, and maintain breastfeeding. Typically, a nipple shield is used at the start of a feeding to encourage the baby to latch on and then removed after he begins to suckle and swallow, but it can be used throughout the feeding. Different types of nipple shields are available, and the effects on breastfeeding are varied. For example, a thick rubber (latex) nipple shield is more likely to interfere with milk transfer than an ultra-thin silicone shield. Nipple shields are intended for short-term use (only until your baby has learned to latch on well or your nipples are no longer flat or inverted). Always talk with your health care provider before using a nipple shield. Because nipple shields can interfere with milk transfer, you should weigh your baby routinely (at least weekly) to make sure he is gaining an adequate amount of weight.
Remember that flat or inverted nipples don’t mark an end to breastfeeding. Many mothers breastfeed their babies despite having flat or inverted nipples. Still, it’s probably a good idea to discuss your concerns with a knowledgeable health care provider or lactation consultant both before and after your baby is born.