Nipples come in all different shapes and sizes, and sometimes the shape of the nipple can make it more difficult to breastfeed or pump. When breastfeeding, the nipple will swell and extend outward as baby draws it into his or her mouth. When you pump, you can watch something similar happening within the flange. A flat nipple does not extend length-wise at all, or very little. An inverted nipple doesn’t extend either, and the areola is drawn around it. It can be challenging to pump or breastfeed with inverted or flat nipples, but it’s certainly possible. Here are some tips for pumping and breastfeeding with flat nipples.
What are flat nipples?
When you’re breastfeeding, your nipple will swell and extend outward as your baby draws the nipple into his mouth, along with some of your areola and breast tissue. Your nipples will also swell when you pump (which is why we recommend measuring for your breastshield size after your nipples have swollen). A flat nipple is a nipple that does not swell as much to extend outward. An inverted nipple stays below the breast tissue and areola, even when swollen. It’s not uncommon for some women to have just one flat or inverted nipple.
Even if your nipple protrudes outward while at rest, it may still be flat (or even inverted) if it isn’t swelling enough to keep up with the tissue around it being drawn into your baby’s mouth. Some women have better luck using a breast pump in these situations because the suction is more uniform with a pump. There’s more information on this below.
How do I know I have flat nipples?
If you’ve never breastfed before, it can be hard to tell if you have flat nipples. Even if your nipples in their resting position protrude, it’s possible you have flat nipples or even inverted nipples. Here’s how you can find out: Cup your breast with your hand, forming a “C” shape with your forefinger and thumb around your areola. Gently apply pressure. Watch your nipple to see if it protrudes outward. If your nipple stays flat, or your breast tissue goes around it while it appears not to move at at all, you may have flat nipples.
Breastfeeding with flat nipples
Flat nipples don’t always cause issue while breastfeeding. However, if you have flat nipples and you suspect they are interfering with how your baby is latching or feeds, there are some techniques you can try.
Try drawing the nipple out before offering it to your baby. You can do this by cupping your breast in that “C” shape around the areola and gently squeezing to form a “nipple sandwitch.” If the nipple doesn’t pop out, you can try grabbing the nipple between your thumb and forefinger with your other hand, and then gently pulling the areola back.
Some women also have luck using a cold compress. When you’re ready to start breastfeeding, try to draw your nipple out and then take a cold wet rag (or breast pad) and apply it directly on the nipple. This will harden the nipple, making it easier for some babies to latch onto.
You can also try using your breast pump for a few minutes prior to breastfeeding. Or, use a nipple shell or suction breast pump (like the Haakaa) before you breastfeed to draw the nipple out.
Keep a close eye on how many wet nappies your baby has – and, if you’re concerned your baby isn’t getting enough breastmilk, you should see a lactation consultant for more help with latch and breastfeeding techniques.
Using a breast pump to improve flat nipples
There are some techniques you can use to help loosen the adhesive tissue that is preventing your nipple from being drawn out while breastfeeding. Think of it like a stretching exercise to help gain flexibility. Some women find that a breast pump helps with this because it creates an evenly distributed suction on your nipple, while a baby’s mouth might suck the tissue around and compress the nipple. According to a Breastfeeding Basics article on flat and inverted nipples,
When a nipple is severely inverted, the baby may compress the nipple buried inside the tissue, rather than the milk sinuses underneath the areola. The sucking action of the pump pulls out the center of the nipple uniformly, rather than compressing the areola. This can help gradually break the underlying adhesions.
A gentle breast pump, like the Pumpables Milk Genie, is ideal for this especially if you have sensitive nipples. Here’s how you can use your breast pump to help improve the elasticity of your nipples:
- Center the breastshield over your nipple and power the pump on. Make sure it’s at its lowest vacuum setting to start.
- Slowly increase the vacuum setting to your comfort level. If pumping is painful, turn down the vacuum level.
- If you’re not pumping to express milk – for example, you’re still pregnant – stop after 5-10 minutes.
- If you’re pumping to express milk, pump until your breasts are emptied.
Repeat this each day. After a while you might notice your comfort level increasing a bit more, and your nipple visibly extending out further. If you’re breastfeeding, a good time to feed is right after you pump as your nipple will be easier for baby to latch onto while its still extended. If you’re finding your nipples are sore or irritated after pumping, place a cold rag over your nipple. You should check that your flange size is correct.
Getting started using a breast pump and finding your breastshield size with flat or inverted nipples can be tricky. If you need help finding your breastshield size, reach out to Pumpables customer support or check out the Fitting Room.
Other methods for drawing the nipple out
The Hoffman Technique
The Hoffman Technique is an exercise you can do with your fingers to help loosen the adhesion in your nipple. Take your thumb and forefinger and apply gentle pressure right below the nipple on the area. Gently roll around your fingers until you feel the nipple (or see it protruding outward). Applying gentle pressure, roll the nipple between your fingers. Make sure you’re not pressing so hard that it’s painful. Work up and down in different directions around the nipple area. Repeat this for several minutes each day. If you notice irritation afterwards, apply cold rag or cold wet breast pad to your nipple afterwards.
Click here for more information on the Hoffman technique.
Nipple shells are like small little suction cups. You can place them over your nipple and the slight suction action acts to draw your nipple out. You can do this for a couple minutes before you begin breastfeeding, or, if only one of your nipples is effected, use the nipple shell on the other nipple while your baby is breastfeeding on the other side (you may experience a letdown). The suction of the nipple shell is a very slight version of what happens when you use a breast pump or when you breast feed. Some women have found success using nipple shells for a few minutes each day, and even during pregnancy, to help alleviate inverted and flat nipples.
While you’re working on alleviating flat nipples, you might experience some pain or irritation while breastfeeding. You can try using a nipple shield while you’re breastfeeding, and you might find after a few weeks that you no longer need it because the elasticity of your nipples have improved. You should seek help from your care provider or lactation consultant if you’re experiencing intense or consistent pain while breastfeeding.