Key takeaways: Babies latch onto the breast, not just the nipple, so many people with flat or inverted nipples breastfeed successfully. Skin-to-skin, breast shaping, brief stimulation or pumping before feeds, and good positioning help. Evidence doesn’t support breast shells or nipple exercises during pregnancy. An IBCLC can help early.
Nipples come in many shapes. Flat or inverted nipples can make latching harder at first, but most babies can learn to latch with support.
Types of Nipples
- Protruding: stick out at rest and with stimulation.
- Flat: don’t stick out much at rest or with stimulation.
- Inverted: pull inward when the areola is squeezed. Some invert only partly.
The pinch test: gently squeeze the areola about an inch behind the nipple. If the nipple pulls in, it’s inverted. If it stays flat, it’s flat.
Does It Matter?
Babies latch onto a mouthful of breast tissue, not just the nipple. Many nipples also become more protractile during pregnancy and after birth. Breast swelling in the early days can make latching harder for anyone.
What About Preparing During Pregnancy?
A randomized trial found that breast shells and nipple exercises (Hoffman’s exercises) during pregnancy didn’t improve breastfeeding outcomes and may discourage some people. They’re not routinely recommended.
Strategies After Birth
- Skin-to-skin right after birth and often.
- Feed early, before breasts get full and firm.
- Shape the breast: compress it gently into a “sandwich” parallel to your baby’s lips.
- Draw the nipple out briefly: roll it gently between your fingers, apply something cold briefly, or pump for a minute or two before feeds.
- Reverse pressure softening: if the areola is swollen, press gently around the nipple for about a minute to move fluid back and make the nipple easier to grasp.
- Try different positions such as laid-back, cross-cradle, or football.
- Nipple everters are small devices that use suction to draw out the nipple briefly. Evidence is limited.
Nipple Shields
A nipple shield is a thin silicone cover that gives the baby a firmer target. It can help some babies latch. Use it with guidance from an IBCLC, who can check fit and milk transfer and help you wean from it when ready.
Protect Your Supply
If your baby can’t latch yet, express milk 8 or more times a day and feed it to your baby while you keep working on latch.
Get help from an IBCLC if: your baby can’t latch, you have pain or damaged nipples, or your baby isn’t gaining well.
The Bottom Line
Flat or inverted nipples don’t prevent breastfeeding for most people. Early skin-to-skin, breast shaping, patience, and skilled help can make latching work.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Sources
- Alexander JM, Grant AM, Campbell MJ. Randomised controlled trial of breast shells and Hoffman’s exercises for inverted and non-protractile nipples. BMJ. 1992;304(6833):1030-1032.
- Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession. 9th ed. Elsevier; 2022.
- Cotterman KJ. Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement. J Hum Lact. 2004;20(2):227-237.
- Chow S, Chow R, Popovic M, et al. The use of nipple shields: a review. Front Public Health. 2015;3:236.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
