Just like her breasts, a woman’s nipples can vary in size, shape and color.

A common variation among the many different sizes and shapes of nipples is flat nipples. Many women worry that having flat nipples means they won’t be able to breastfeed their babies.

In some cases, pregnancy and/or breastfeeding helps to bring an otherwise flat nipple outward. In other cases, a little extra help is needed so that a mother can breastfeed her baby effectively.

In any case, having flat or inverted nipples doesn’t mean that breastfeeding will be impossible.

Read on to find out how to improve breastfeeding with flat nipples.

How common are flat nipples?

Flat nipples are considered a normal nipple variation and are present in up to 20% of people. Inverted nipples occur in a smaller segment of the population – between 3 and 10% of people. Most people with flat nipples are born with them.

Breastfeeding with flat nipples

Unfortunately, many women are told that their breastfeeding difficulties are due to having flat nipples. Some women are even told by various health professionals that they can’t breastfeed with flat nipples.

This is untrue.

When babies breastfeed, they take not only their mother’s nipple into their mouths but also a portion of the surrounding breast tissue. If babies took only their mother’s nipple into their mouths while feeding, this would result in a very shallow latch that could cause the mother pain, and would also be ineffective in transferring milk from the breast.

When a baby latches on and takes in a big mouthful of both nipple and surrounding breast tissue, many mothers find that their nipples are naturally more everted when the baby comes off the breast.

Flat vs inverted nipple: what’s the difference?

A flat nipple is when the nipple lies even with the surrounding areola and breast tissue. Some women’s nipples will stay flat all the time; others’ will evert with manual stimulation from their baby’s suck or with a breast pump.

An inverted nipple is when the nipple is retracted inwards and dimples in at the center, instead of pointing outwards. Flat nipples can be either unilateral or bilateral, meaning they can be present in one or both nipples. Breastfeeding is still possible with inverted or flat nipples.

Would using a nipple shield help breastfeeding with flat nipples?

Nipple shields are thin silicone covers, which are placed over the nipples while breastfeeding. They create a longer and firmer base, making it easier for your baby to latch to the breast.

To apply a nipple shield, flip the outer edge of the shield as though you are going to turn it inside-out, but only invert it halfway. Position the shield over your nipple so that your nipple is in the center of the teat. Roll the flipped-over portion of the shield onto your breast, allowing your nipple to be drawn up over the teat.

Many shields have a cut out section, to maximize skin-to-skin contact while breastfeeding. If you need to use nipple shields, it’s best to do so under the guidance of a lactation consultant.

For more information, you can read BellyBelly’s article Nipple Shield – 6 Important Questions About Nipple Shields.

Helping your baby latch using reverse pressure softening

In the early days and weeks postpartum, while your milk supply is still largely hormonally driven, you might find that your breasts become very full between feeds. If you have flat or inverted nipples, this can make it difficult for your baby to attach himself to the breast.

Reverse pressure softening is a technique that can help relieve some fullness and swelling from the area surrounding the nipple and areola. It makes it easier for your baby to get a deeper attachment.

Here are some common methods for reverse pressure softening:

#1 One handed flower hold

Making sure your fingernails are short, use one hand to place your fingers in a curved shape around the base of your nipple
Press inwards towards your chest wall for about 1 minute
Maintain a firm and steady pressure but do not press so hard that it causes pain
Repeat this step 2-3 times or until the surrounding breast tissue has softened.

#2 Two handed with fingers

Making sure your fingernails are short, place three fingers of both hands on either side of your nipple, with the fingertips pointing toward each other
Press your fingertips into the base of your nipple, towards your chest wall
Maintain a firm and steady pressure for about 1 minute
Repeat this step 2-3 times or until the surrounding breast tissue has softened.

#3 Two handed with thumbs

Making sure your fingernails are short, place a thumb on either side of your nipple
The base of the thumbnails should be in line with the nipple
Pressing towards the chest wall, maintain a firm and steady pressure for about 1 minute
Repeat this step 2-3 times or until the surrounding breast tissue has softened.

Managing engorgement

Engorgement is more than just feeling full between feeds. Most often, it occurs in the early days of breastfeeding, when colostrum is transitioning to mature milk.

Engorgement can cause a breastfeeding mother’s breasts to become extremely swollen and painful, and her nipples to become stretched flat or inverted. This makes breastfeeding very challenging for a mom who already has flat or inverted nipples.

The fastest way to relieve engorgement is to remove milk by gently hand expressing or breastfeeding your baby. Cool packs can help reduce inflammation; you can also try over the counter anti-inflammatory medications.

For more information on engorgement, you can read BellyBelly’s article Engorgement – Relief For Breast Engorgement.