Flat and Inverted Nipples

By Krista Gray, IBCLC. Last updated October 8, 2013.

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Nipples come in all shapes and sizes.  Two variations, flat and inverted, can present breastfeeding challenges in the beginning. However, neither makes breastfeeding impossible.  Babies take in a large portion of a mother’s nipple, areola, and breast tissue to form a teat in their mouths.  The nipple is in the back of baby’s mouth where the junction of the hard and soft palate meet.  It is called breastfeeding for a reason; and it is still completely possible for a mother with these nipple variations to exclusively breastfeed her baby from the very beginning.

How are flat and inverted nipples problematic for breastfeeding?

Nipple inversion occurs in about 3% of women, while another 10% – 35% or more will have nipples with poor protractility.1  Flat nipples can make it challenging for a baby to find and initially latch onto the breast.  Some nipples appear inverted but become erect when stimulated. There are typically no breastfeeding challenges with this type of inversion.  On the other hand, some nipples appear to be graspable but actually invert further with stimulation.  Both flat and inverted nipples usually benefit from techniques that increase its extension.

What can I do about a flat or inverted nipple?

Sometimes flat or inverted nipples will resolve themselves during the course of pregnancy. Many other cases do not display a degree of inversion that it significantly affects a baby’s ability to latch onto the breast – especially with an attentive mother helping baby latch well in the early days.  Many women find that the degree of inversion lessens the longer they breastfeed as well as subsequent pregnancies having much less inversion than before their first pregnancy.2

To help extend a flat nipple, many moms find it helpful to put a cold cloth on the nipple immediately before breastfeeding or to gently massage it.  Inverted nipples may benefit from taking a pump or syringe (cutting off the end with the point and putting the plunger in the opposite end so that the smooth end touches the nipple/areola) to help extend them before nursing. Nipple shields can also be helpful in creating a silicone nipple for baby to latch on to.  Nipple shields are very thin and should not impede milk flow.  However, nipple shields should not be used before a mother’s milk has “come in.”

Make sure to have qualified lactation support

Flat or inverted nipples can be a cause excessive weight loss and/or slow weight gain in the first week following birth.3  They can be a source of stress when initiating breastfeeding and it is extremely important for a mother to have excellent lactation support.  If you have flat or inverted nipples, there is nothing you need to do during pregnancy to change them.  Once your baby arrives, insist on talking with a qualified lactation consultant so she can help you with proper positioning and attachment to aid your baby’s breastfeeding success.

Show 3 footnotes

  1. Mannel, R. (2013) Core Curriculum for Lactation Consultant Practice. Burlington, MA: Jones & Bartlett Learning.
  2. Riordan, J. & Wambach, K. (2010) Breastfeeding and Human Lactation. Sudbury, MA: Jones and Bartlett Publishers, p. 292.
  3. Vazirinejadl, Reza. (2009). The effect of maternal breast variations on neonatal weight gain in the first seven days of life. International Breastfeeding Journal 4:13.