Flat or Inverted Nipples

Use the breast sandwich method to get more breast tissue into your baby's mouth. Grasp your breast well back on the areola, with your fingers below and thumb on top.

breastfeeding, breastfeeding compressions, baby breastfeeding
A mother holds her breast so that her baby can breastfeed. 

Some types of nipples, like concave, flat, or inverted nipples, might make it more difficult for a baby to latch. For a baby to nurse successfully, they must be able to grasp the nipple and stretch it forward and upward against the roof of the mouth. The most important thing to remember is that your baby should get as much of your breast into the mouth as possible.

Flat or inverted nipples are caused mainly by adhesions, which never opened up naturally during puberty. During nursing, there will be some pain as the nipples are pulled out, but it is temporary, and the nipples usually stretch out over time.

Most times, mothers will have one inverted nipple. In this case, you will be able to feed your baby on the “good side" while you pump the other side. You can always keep the pumped milk for times when your baby needs a bottle.

flat nipples, inverted nipples, flat and inverted nipples,
Baby is lying with his head on mom's shoulder.

If your baby is strong, healthy, full-term, and vigorous, they may be able to draw out the nipple easily.

Some good news is that the more you breastfeed, the larger your nipple will become, and the more it will stand out. Breastfeeding will, therefore, become easier with each baby.

How Do You Know if You Have Flat or Inverted Nipples?

Gently compress your areola about an inch behind your nipple. If your nipple does not bulge out, it is a flat nipple. If your nipple concaves, it is considered to be inverted. Flat and inverted nipples will never become erect when stimulated or when cold. If you have small nipples, you should not have a problem getting your baby to latch on.

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Inverted Nipples / Flat Nipples
Treatment Options

  • Nipple formers: Also called breast shells, milk cups, or breast cups. These shells are used to help the nipple protrude. They can be worn a few months before the baby is born and before a breastfeeding session.
  • The Niplette: This device sucks out the nipple; it stretches the ducts and then makes breastfeeding possible. This device can be used during pregnancy to get your nipples ready to breastfeed.
  • The Hoffman Technique: Pressing down and pulling away from the nipple with your thumbs a few times. Do this up and down and sideways. The Hoffman process will help your nipple move outwards and can be done about five times daily.
  • Using a breast pump: A breast pump can be used every time, just before breastfeeding. A pump will pull the nipple out.
  • Use the breast sandwich method to get more breast tissue into your baby's mouth. Grasp your breast well back on the areola, with your fingers below and your thumb on top. Push in with your thumb and fingers, and at the same time, push back toward your chest wall. This will elongate your areola, which will help your baby latch on easier.
  • A nipple shield: nipple shields are fake nipples, which are not recommended as it may ultimately decrease your milk supply but can sometimes help mothers breastfeed when all else fails.
  • The Lansinoh Latch Assist: Can be used to pull the nipple out just before a breastfeeding session. Explained in the video below...
the u hold, flat nipples, breastfeeding problems
Another Variation of The Breast Sandwich Method

Things You Can Do That Might Help

  • Nipple stimulation: You can roll your nipple in your hands or place something cold on it for a few minutes to make it stand out.
  • With an inverted or flat nipple, you will need to nurse as soon as possible after birth and every 2-3 hours after that. This is to avoid engorgement; breast engorgement can push flat nipples out, making them even harder to grip.
  • Make sure that your baby is latching on correctly.
  • Try calming your baby before breastfeeding. Use calming techniques.
  • As a last resort, the mother might feel that she would alternatively prefer to pump exclusively.


Inverted Nipples on Both Sides

"Hello, my baby is now four weeks old; I'm still not breastfeeding; I have two problems. First, I have inverted nipples on both sides, so my baby cannot latch.

The second problem is the low milk supply, although it's increasing gradually. I was pumping less than 1 oz a day. Now I'm pumping 5 oz a day.

I tried the nipple shield, which was working at first, but now my son is refusing my breast - he's not even trying to suck, although I can see that milk is coming out of the shield.

I'm still trying, but I want to hear your advice.

Thank you"

Re: Help
by Lyssa

"Hello! Breastfeeding with inverted nipples can be challenging. The first step would be contacting a lactation consultant for hands-on help.

An option many with a low supply try is to use an SNS (supplemental nursing system). A tiny tube is taped next to your nipple and connected to a bag of milk (or formula). This way, a baby is nursing at the breast and stimulating milk production while getting milk from the SNS.

Increase pumping to every 2-3 hours if you haven't already. It would be best if you also used a double electric breast pump for the best results. Hand expressing or pumping ten-twenty minutes after you feel "empty" will also help increase supply.

You can take natural "milk boosters" such as oats (In the form of oatmeal, cookies, etc.) or flaxseed (throw them into cookies or even in a smoothie!).

But the most critical first step would be to contact a lactation consultant in your area.

You can do it!"