Tips for Breastfeeding With Inverted Nipples

Mom breastfeeds newborn baby

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When you’re preparing to breastfeed your baby, you may spend a lot of time fretting over all the things that could go wrong. Will you make enough milk? What if your baby has a tongue-tie? And just how badly is it going to hurt you?

One thing you probably don’t spend time thinking about is the anatomy of your nipples—and whether yours are conducive to typical breastfeeding. In reality, a lot of women have normal anatomical variations to their nipples.

The most common difference is having flat or inverted nipples, sometimes also called retracted nipples. This doesn’t affect your ability to produce breast milk or breastfeed your baby, but it can make breastfeeding a little bit trickier (at least initially).

To breastfeed successfully with inverted nipples, you’ll need some assistance, practice, and patience. The practice and the patience are up to you, but we can help with the assistance part! Here’s everything you need to know about breastfeeding with flat or inverted nipples.

What Are Inverted Nipples? 

Rather than protruding outward the way nipples usually do, inverted nipples either lie flat against the areola or turn inward into the areola. This may be most noticeable when pressure is applied to the areola.

If you gently squeeze the area around your nipple and it doesn’t become erect, you have a flat nipple; if it actually retracts or sinks into the areola, it’s inverted.

The degree of flatness or inversion varies a lot, and not just from person to person—an individual may have two fully inverted nipples, one inverted nipple and one typical nipple, or one or more nipples that are only partially inverted.

What Causes Inverted Nipples?

Many women are born with inverted nipples. In fact, about 10 percent of women have at least one, and in most cases, it’s not caused by any other medical condition. It doesn't hurt or cause any specific problems.

Generally, if you’re born with one or more inverted nipples, you don’t have to worry about them. But if an inverted nipple is a new thing for you, it’s worth getting it checked out. Sometimes pregnancy itself is the cause for this change, but rarely, an inverted nipple can be a sign of something more serious, like breast cancer.

Inverted nipples can also appear after breast surgery, breast trauma, during menopause, during or after mastitis, or even after breastfeeding (if you experienced any scarring of your milk ducts).

Are They Permanent?

Maybe, or maybe not! It depends on how inverted your nipple is—nipples that are only slightly inverted may begin protruding more over time, especially as you go through the typical life cycle of female reproductive changes (i.e. menstruation, pregnancy, breastfeeding, and menopause).

Physical changes, like changes in temperature or sexual arousal, may also temporarily affect the appearance of your inverted nipple or nipples.

If your inverted nipple is simply a genetic abnormality, you don’t need to do anything to treat it. You may want to, though, if you have strong feelings about the appearance of your inverted nipple or are worried about your ability to breastfeed in the future.

There are ways you can encourage a nipple to reverse its natural direction, though there’s no guarantee these will work or that you’ll be able to maintain the results:

  • The Hoffman technique, a manual therapy involving massage of the breast tissue and areola.
  • Nipple extractors or breast shells, like the Lansinoh LatchAssist, which place reverse pressure on the breast tissue so the nipple protrudes. 
  • Suction techniques, similar to breastfeeding pumps, which draw the nipple out and away from the areola. 

You can also opt for plastic surgery. There are surgical correction procedures as well as cosmetic injections which can turn your nipple outward. In the past, surgery used to involve severing the milk ducts behind the nipple, meaning a woman could no longer breastfeed, but modern procedures preserve the milk ducts, instead stretching out the connective tissue so the nipples can protrude.

Impact on Breastfeeding

There is no anatomical reason why a woman with inverted nipples cannot breastfeed. The condition doesn’t affect your milk ducts, so you will still produce milk, and that milk will still be able to flow out from the nipple. 

In fact, midwives, lactation consultants, and other breastfeeding experts are known to remind women that it’s called breastfeeding, not nipplefeeding, because while the nipples play an important role, they are not the only body part responsible for successful feeding!

The act of breastfeeding itself can often be a “treatment” for inverted nipples. The repeated force of your baby sucking on your breast during feedings can loosen the adhesions causing inverted nipples, allowing the nipple to protrude more over time. 

That said, there is usually a larger learning curve to breastfeeding when you’re working with inverted nipples. It may take more practice for you and your baby to get a good latch (a critical component of successful breastfeeding), and you may need to prep your nipples ahead of feeding sessions, using stimulation techniques, or even adjust your breastfeeding position so your baby can latch on more easily.

There are several products you can use to make breastfeeding easier with inverted nipples: 

  • Breast shields: Firm plastic cups or shells worn between feedings to keep the nipple in an outward position
  • Nipple shields: Flexible silicone devices worn over your nipple and areola during feedings that simulate an erect nipple and make it easier for your baby to latch
  • Breast pumps: Used to stimulate the nipple before a feeding (before being swapped out for the breast) or used exclusively to feed your baby (via pumping and bottle feeding)

Two things to note: The effectiveness of breast shields in reversing nipple position may only be temporary, and nipple shields can interfere with your milk supply (and overall success with breastfeeding) when used for more than a few weeks.

It’s a good idea to consult with your OB/GYN, midwife, or even an independent lactation consultant before using one of these strategies to breastfeed with inverted nipples.

Impact on Milk Supply

Remember, an inverted nipple has no effect on your milk ducts or on how much milk is produced or distributed to your baby.

There’s a small catch, though. Since inverted nipples can make it hard for your baby to latch onto your breast fully for feedings, they can disrupt the delicate supply-and-demand balance of breastmilk production. 

What do we mean by that? Well, your body knows how much milk to make for your baby’s unique needs based on how long and how often your baby feeds, as well as how strong their sucking reflex is. An inverted nipple can be frustrating for a newborn, who may not be able to figure out how to latch onto the breast, so your baby may have a hard time “demanding” the right amount of breastmilk “supply” to fill their belly.

In this way, inverted nipples can reduce your overall milk supply, but all by themselves, inverted nipples don’t directly influence the amount of milk you can produce or feed your baby.

A Word From Verywell

If you have inverted nipples, you may have been nervous to learn how they may impact your ability to breastfeed your baby. But as we've shared here, the good news is you can find success through these tips and a little bit of patience. If you do find breastfeeding challenging, be sure to seek advice from your doctor or a lactation consultant.

By Sarah Bradley
Sarah Bradley is a freelance health and parenting writer who has been published in Parents, the Washington Post, and more.