Is breastfeeding with flat or inverted nipples possible?

Flat nipples barely protrude. They may come out with stimulation.
In this case, an accessory called a "Niplette" can be used.

Inverted nipples have an indentation at their centre. There are different degrees of inversion. A slight inversion will not cause problems for a baby with a normal latch. A newborn or premature baby may find it more difficult at first. A more pronounced inversion will result in the nipple retracting into the breast tissue when the areola is compressed.

Pinch your areola between your thumb and index finger (the areola is the darker area around your nipple).
If the nipple does not come out, it is considered flat.
If it retracts, or even sinks inward, it is considered inverted or retracted.
Please note that an inverted or flat nipple may occur on one side only.

In the first few days, when sucking has not yet been fully established and your baby is not yet latching well, inverted or flat nipples can make initiating breastfeeding more difficult. This is even more likely if the baby was born prematurely, has sucking difficulties, or is not in good health.

If your baby latches well onto your finger but seems less interested in your breast, this may indicate that your nipple is not far enough into the palate. Seek support from an IBCLC lactation consultant, who can assess your baby's latch.

It is true that babies do not latch onto the nipple itself. Studies do, however, highlight the importance of protractility (i.e. the ability of the nipple to protrude from the breast and be stretched) for breastfeeding.

If the nipple cannot protrude properly, it will end up at the junction of the hard and soft palate, rather than at the soft palate at the back [4]. This exposes it to greater suction, and therefore potentially more pain, or even cracking…

To better understand, place your thumb in your mouth so that your lips touch the base of your first phalanx. Your thumb will then reach the top of your soft palate. If you suck on it there, you will barely feel any suction. However, if you place it in the middle of your mouth or even further forward, the pressure from the suction will be much stronger.

Finally, if the nipple does not stretch correctly, the soft palate may not be sufficiently stimulated to trigger a sucking reflex.

These soft silicone discs apply gentle pressure to your nipples, helping them to protrude through the hole in the disc.

Towards the end of pregnancy
Nipple formers can be used towards the end of pregnancy. By applying gentle but constant pressure to separate the tissue and break down adhesions, they gradually help the nipple to protrude.
You can also use a Supple Cup, a silicone device that applies gentle suction to the nipples. Use it for an average of 3 to 4 hours per day.
Please do not use them if you have cervical incompetence or other risks of premature labour. Stimulating the nipples can trigger contractions.
Consult a healthcare professional who can advise you on how to use them.

After the birth
After the birth, you can also wear them for half an hour before breastfeeding to help draw the nipple out. Avoid wearing them at night.

After birth, a breast pump can be used to draw out inverted nipples just before feeding if needed, to make it easier for the baby. A reversed syringe can also be used.

In cases of severely inverted nipples, the baby will compress the nipple rather than the breast and milk ducts. This can cause pain for the mother and make it difficult for the baby to extract milk. 

A breast pump applies constant pressure to the areola and, over time, can break down the adhesions that keep the nipple inverted. For some mothers, a single pumping session is enough to bring the nipple out fully. For others, several sessions may be needed [5].

If you have just one breast with a severely inverted nipple, you can express milk from that side and offer the other breast to your baby first.

Another less time-consuming option recommended by La Leche League (since using a breast pump 8 to 12 times a day is really not practical!):
- Pinch your nipple and roll it between your thumb and index finger for 1 to 2 minutes.
- Then quickly apply a cool cloth or ice wrapped in a cloth over it.

With this method, your nipple should come out and make latching easier if needed.
Be careful not to apply ice for too long, as numbing the nipple or areola can inhibit the milk ejection reflex!

Before a feed, you can draw your breast towards you (thumb on top, four fingers underneath, pushing the breast towards your ribcage) for a few minutes. This movement should encourage milk let-down and help your nipple to come out. You can also compress your breast during the feed to help with milk transfer.

Nipple shields are flexible silicone films shaped like a nipple, designed to be worn during breastfeeding. They have a hole in the centre to allow milk to flow through. They can temporarily help a baby to latch on, stimulate the roof of their mouth and their sucking reflex.

The size must be suited to the diameter of the nipple. In this case, it is strongly recommended to be supported by an IBCLC to ensure adequate milk production and good milk transfer.

Please note that nipple shields should only be used with the support of an IBCLC lactation consultant, as they can cause problems if not used correctly.

It is worth noting that a 1997 English study of 3,000 women showed that breastfeeding rates at 6 weeks were significantly lower among women who had been advised to use nipple shields due to flat or inverted nipples.

For those who had done "exercises" to draw them out, no significant difference was found compared to those who had made no preparation at all [6].

If you have flat or inverted nipples, getting support from an IBCLC lactation consultant can be invaluable.

Your baby needs to learn to open their mouth wide enough (as if they were about to bite into a large burger). An IBCLC will help you get breastfeeding off to a good start and build your confidence, helping you to correct things if needed.

- you are comfortable and relaxed, with no tension
- your baby's tummy is pressed against you
- they are well latched to the breast: in the first few days it can be hard to see their mouth (only their upper lip and cheeks are visible)
- your baby should have their mouth wide open, lips well flanged outwards to create a good seal around the breast

An asymmetric latch (especially at birth) can help your baby open their mouth wide enough. What does this mean? Your baby's mouth should not latch onto the breast in a centred position. Their lower lip should cover a larger area of your areola than their upper lip. Their nose should touch (but not be pressed against) the breast.

It is recommended to see an osteopath or chiropractor in the first few weeks of life to release any tension your baby may be carrying. This tension could lead to an incorrect latch and, as a result, poor milk transfer, and sometimes pain for the mother.

Please note: In the first few days after birth, avoid holding the top or back of your baby's head firmly. It is very sensitive, and doing so may trigger a reflex that causes your baby to pull away from the breast. Instead, support your baby at the nape of the neck.

To find out more, have a look at our article on breastfeeding position.

Ideally, a newborn should feed within the first hour of life. If needed, express some colostrum with a small spoon to stimulate and nourish your baby.

These first feeds will help them "practise" before your milk comes in, on breasts that are still soft and easier to latch onto.

Closeness is fundamental in the first days of life. Breastfeeding will become established much more easily. Skin-to-skin contact is strongly recommended!

If your baby becomes agitated, remove them from the breast and take a moment to calm them down (by carrying them, rocking them…).

Some mothers may experience discomfort during the first two weeks of breastfeeding, while their flat or inverted nipples adjust and extend.

Pain is not normal. An IBCLC lactation consultant can support you at the start of your breastfeeding journey.

If your nipples cannot extend properly in your baby's mouth, the suction pressure will be greater, which may cause pain.

In cases of extreme discomfort, do not hesitate to consult an IBCLC.

If your nipples retract again after feeds, the skin of the nipple may remain damp, leading to skin irritation or even breastfeeding nipple cracks.

After breastfeeding, make sure to dry your nipples thoroughly.

If the pain continues, it may mean that instead of stretching, the adhesions remain tight, which can then cause cracking or chapping. Don't hesitate to seek advice!