To get a good latch, babies need to open wide and take in a mouthful of breast tissue. For some moms this is difficult because they have flat or inverted nipples, making latching on a struggle. Ideally, the nipple will be erect and have a nice shape to it so the baby's mouth opens wide when it feels the nipple being touched to the upper lip.
To check to see if you have flat or inverted nipples, try the "pinch test" by compressing your areola just behind the nipple. If your nipple shape stays flat, you have flat nipples, and if it slightly retracts into your breast, then it's inverted. When the nipple is flat or inverted, babies may have difficulty locating the nipple or refuse to latch on. Thankfully, there are a handful of solutions for flat no matter the level of inversion.
Reverse Pressure Softening
Some moms will temporarily experience flat nipples as a result of engorgement. Swelling of the breast tissue can cause the nipple to retract and for the breast to be too firm for the baby to latch onto. Using the “reverse pressure softening” technique can help displace some of the extra fluid associated with engorgement and draw the nipple out. To perform reverse pressure softening, you will use the tips of your three middle fingers from each hand to apply pressure into the chest/breast, around the base of the nipple. You can start with one hand coming from above the breast and the other hand coming from below the breast. Hold continuous pressure in the same location for approximately five seconds before rotating your hands so they are to the left and right of the nipple. You will want to continue applying pressure above/below and on both sides of the nipple for about 30-60 seconds total - rotating your hands approximately every five seconds. The result should be that the area around the nipple is softened and breast milk has begun to leak.
Moms with “shy” nipples (meaning the nipple starts out flat but becomes erect after stimulation) may find using their hands to “roll” the nipple before breastfeeding does the trick. To roll the nipple, you will want to place your hand about a half inch away from the nipple - with your thumb above and your fingers below the nipple. Next, you will move your thumb and fingers back and forth along the areola/base of the nipple as if you were rubbing a piece of fabric between your fingers to see how soft it was.
Using a Breast Pump
Another way to prime the nipple for breastfeeding and give it instant shape is to pump for about one minute prior to bringing the baby to the breast. The vacuum pressure an the electric breast pump applies just enough suction to draw the nipple out, helping your baby latch easier. If you do not have an electric pump, a hand pump can be used instead.
Nipple shields can also be used to help babies latch on when flat or inverted nipples are the challenge. They are thin, flexible silicone devices worn over your nipple, and can also help treat sore nipples. If your baby uses a nipple shield, but does not totally empty the breasts while nursing, it’s recommended to pump for a few minutes after feeding to remove any residual milk.
There are also helpful products available to assist with drawing out flat or inverted nipples. A nipple everter like this one from Lansinoh is used just before breastfeeding to gently add shape and help the nipple protrude. The nice thing about this tool is that it does not need to be plugged in or set up and is a quick and simple solution to flat nipples.
Unlike the nipple everter, breast shells are worn in your bra between feedings and provide continuous reverse pressure around the base of the nipple so you are ready to breastfeed at any time.
Over time, with the use of the breast pump and/or breastfeeding, many new mothers find that their nipples begin to take on more shape. This is good news for moms with flat or inverted nipples since it may mean you will not need to do anything special to prepare your nipples for breastfeeding long-term. For more personalized help or troubleshooting, you may want to reach out to a lactation consultant or IBCLC, especially if these issues cause soreness or milk supply concerns.
Hanna S, Wilson M, Norwood S. A description of breast-feeding outcomes among U.S. mothers using nipple shields. Midwifery. 2013 Jun;29(6):616-21. doi: 10.1016/j.midw.2012.05.005. Epub 2012 Jul 12. PMID: 22795179.
Nabulsi M, Ghanem R, Abou-Jaoude M, Khalil A. Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: a study protocol for a randomized controlled trial. Trials. 2019 Dec 16;20(1):737. doi: 10.1186/s13063-019-3880-8. PMID: 31842992; PMCID: PMC6916061.