During pregnancy, it’s common to notice changes in your breasts and wonder how they might affect breastfeeding. If you have flat or inverted nipples, you may worry that this could make breastfeeding difficult or prevent you from meeting your breastfeeding goals.

The good news is that many mothers with flat or inverted nipples breastfeed successfully. While there can be a learning curve—especially in the early days—understanding your breast anatomy and having the right support can make a meaningful difference.

Understanding Your Breast Anatomy

Flat and inverted nipples are normal variations of nipple shape and are most often present from birth. While they can sometimes create breastfeeding challenges, they do not automatically prevent successful breastfeeding.

Here's some encouraging news: babies don’t nipple feed—they breastfeed. They don't suck on the nipple like a straw. Instead, effective milk removal depends on getting a deeper latch, where your baby opens wide and takes a mouthful of breast tissue, including a portion of the areola. In this position, the nipple rests comfortably toward the roof of your baby’s mouth, allowing effective feeding even when the mother’s nipples are flat or inverted.

Flat Nipples

A flat nipple lies at the same level as the areola or appears as a smooth, gradual transition rather than projecting outward. Flat nipples often respond to gentle stimulation and may “perk up” temporarily. With support and practice, the baby’s latch and your comfort often improve over time.

Inverted Nipples

An inverted nipple pulls inward toward the breast in its natural, relaxed state. Inverted nipples are commonly categorized by how easily they evert and the flexibility of the underlying tissue:

  • Grade 1 (Mild Inversion): Sometimes called “shy nipples.” These nipples are inverted at rest but have normal milk ducts and minimal restriction. They evert easily with stimulation or suction, and breastfeeding is usually not impacted.

  • Grade 2 (Moderate Inversion): These nipples can be pulled outward but tend to retract once stimulation stops. Some restriction may make maintaining a deep latch more difficult, and additional lactation support or interventions are often helpful.

  • Grade 3 (Severe Inversion): This level of inversion includes significant bands of connective tissue and, in some cases—short milk ducts—preventing the nipple from being pulled outward. This can contribute to painful feedings, nipple damage from a shallow latch, and increased risk of moisture retention, skin breakdown, and recurrent mastitis. Individualized lactation support and alternative feeding strategies may be needed to protect both comfort and milk supply.

Prenatal or Early Interventions

Once you understand your breast anatomy, there are gentle techniques you may want to try during pregnancy or in the early postpartum period to make breastfeeding easier. These interventions can support comfortable breastfeeding, build confidence, and may help you get off to a good start.

Breast Shells

Breast shells are smooth plastic or silicone cups worn inside a bra to apply gentle, continuous pressure, helping to draw out flat or inverted nipples. They can be used during pregnancy to encourage nipple eversion and postpartum in between feedings to maintain the shape of your nipple and help improve airflow. While breast shells may provide some improvement, they are usually most effective when used alongside other techniques.

Nipple Everters

Nipple everters are small, gentle devices designed to help draw out flat or inverted nipples, making it easier for a baby to latch. They can be used during pregnancy to encourage nipple eversion or in the early postpartum period before feedings. Research shows that simple alternatives, such as a modified inverted syringe, can provide similar gentle suction to help protrude nipples. When used correctly, nipple everters can make it easier for your baby to latch and support breastfeeding success

Hoffman’s Exercise 

This stretching exercise can help nipples evert more easily and has been shown to increase breastfeeding success for mothers with flat or inverted nipples. It can be done up to five times daily and may be practiced during both pregnancy and postpartum.

  1. Place the thumbs on opposite sides of the base of the nipple.

  2. Press firmly into the breast tissue.

  3. While maintaining pressure, gently pull the thumbs away from each other.

  4. Move your thumbs around the nipple in vertical and horizontal directions while repeating the gentle stretch several times per day.

Temporary Difficulty

Initial postpartum breast engorgement can make a nipple appear flatter than usual or cause it to dimple inward with gentle compression, even if it normally everts. This can make latching more challenging. Engorgement is usually temporary and often improves within a few days. Frequent breastfeeding or pumping, cold compresses, and, if recommended by your healthcare provider, anti-inflammatory medication can help relieve discomfort. Expressing a small amount of milk to soften the breast can also make the nipple more accessible, helping your baby latch more easily and comfortably.

Tools for Breastfeeding Success

Many flat or inverted nipples improve naturally over time due to hormonal changes during pregnancy and lactation, and with regular breastfeeding or pumping. Nipples that are initially challenging often become easier for a baby to latch with practice and support.

Reverse Pressure Softening

This technique moves swelling upward into the breast—away from the nipple—providing relief from engorgement and helping the nipple to evert. To begin, place two fingers on the areola and apply gentle pressure inward towards the chest wall for 30–60 seconds, moving around the areola. Massage the breast in soft circles and repeat as needed.

Hand Expression

Hand expression uses your hands to remove milk from the breast, which may help protrude flat or inverted nipples. In addition, gentle manual stimulation, or “twiddling,” can be added to help draw out the nipple. Many mothers use hand expression in the early days postpartum to make latching easier for the baby before offering the breast or afterward to collect additional colostrum, helping stimulate a quicker transition to abundant milk production.

Nipple Shields

A nipple shield can be a temporary tool to improve a poor latch and help improve feedings, helping you gain confidence as you and baby are getting started. Nipple shields should be used with the support of a lactation consultant to check for effective milk transfer. The shield should fit securely over the nipple and areola, which may be more challenging with inverted or flatter nipples. Visible breast movement and milk on the tip of the shield are signs it’s the correct size and being used properly.

 

What About Pumping?

Pumping can be used as an intervention to help your baby latch more effectively. A few minutes of gentle suction with a manual or electric breast pump can help draw out the nipple, making it easier for your baby to achieve a deep, comfortable latch.

Pumping also protects your milk supply if your baby is struggling with breastfeeding. Milk production relies on frequent breast emptying in the early weeks. Following a pumping session with a few minutes of hand expression can collect additional colostrum and ensure more complete breast emptying, which promotes increased milk production. Pumping is breastfeeding and allows you to continue providing optimal nutrition while you and baby are still working on feeding directly at the breast.

Support for Your Journey

Many flat or inverted nipples improve naturally over time with breastfeeding and pumping. Understanding your breast anatomy and how breast milk is made can help you feel more confident in your breastfeeding journey. If you’re concerned about flat or inverted nipples affecting feedings, reach out to a lactation consultant for evidence-based guidance and personalized support.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.