Inverted or flat nipples and breastfeeding

What are inverted or flat nipples?

Inverted or flat nipples are nipples that don’t stick out from your areola (the darker area around your nipple). Everyone’s nipple shape is slightly different, and may be:

• protruding — when the nipple sticks out from the areola
• flat — when the nipple is level with the areola
• inverted — when the nipple is pulled inward from the areola

Around 6 in every 100 females have inverted or flat nipples.

One or both nipples may be inverted or flat.

The shape of your nipple will vary over time. Changes to your body during pregnancy can cause your nipples to become flexible and stick out more. If you usually have inverted or flat nipples, they may protrude during pregnancy or breastfeeding.

What causes inverted or flat nipples?

Inverted or flat nipples are caused by natural differences in breast tissue. These differences in shape are common, and do not mean there is anything wrong with your nipples.

You can usually tell if you have inverted or flat nipples by looking at how your nipples sit on your areola. You can also gently press either side of your areola. If your nipple:

• sticks out, this means it’s protruding
• stays level, this means it’s flat
• pulls inwards, this means it’s inverted

Can I breastfeed if I have inverted or flat nipples?

Having inverted or flat nipples does not mean you won’t be able to breastfeed.

You may need help to make your nipples stand out, or to get your baby to attach, at first.

How can I help my nipples to stand out?

Here are some tips to get your nipples ready for breastfeeding:

• Try gently drawing out your nipple by hand or with a breast pump.
• Use nipple stimulation or a cold compress.
• Express a small amount of breast milk to soften the area around your nipple.

How can I help my baby attach to my nipples?

Here are some tips to help your baby attach:

• Start breastfeeding as soon as possible after birth. In the first few days, your breasts are usually softer, which makes it easier for your baby to attach.
• Hold your baby skin-to-skin as much as possible in the first few days after birth. This helps to support your baby’s natural feeding instincts.
• Try to avoid using bottles and dummies as they are a very different shape to your nipple. If your baby needs extra milk, feed them using a cup or syringe.

If your breasts become engorged (very full), it may be harder for your baby to attach. If this happens, there are ways to soften the area around your nipple, such as:

• expressing a small amount of milk by hand
• using a breast pump for a short time
• gently massaging your breast

How do I use a nipple shield?

Nipple shields are thin silicone covers that can be placed over your nipple to help your baby attach during breastfeeding.

Here is some more information about nipple shields:

• You can buy nipple shields from pharmacies or baby supply stores.
• Your milk may flow slower when using a nipple shield, so each feed can take longer.
• Using a larger nipple shield can help your milk flow.
• If you use nipple shields, it’s recommended that you have your baby weighed regularly — this is to make sure they are growing well.

Here are the steps to follow when using a nipple shield:

1. Express a few drops of breast milk to help your milk start flowing.
2. Put a small amount of milk on the outside of the nipple shield to encourage your baby to attach.
3. Place the nipple shield over your nipple and hold it in place by the outer edge.
4. Touch your baby's lips to the nipple shield and then bring your baby onto it once they open their mouth.
5. Make sure your baby is sucking and swallowing during breastfeeding.
6. After breastfeeding, rinse the nipple shield in cold water, wash it in hot soapy water and then rinse it under hot running water.
7. Dry and store the nipple shield in a clean, covered container.

Who can I see if I’m having trouble with breastfeeding?

If you are having trouble breastfeeding, you can get help from a:

• lactation consultant
• midwife
• child health nurse
• Australian Breastfeeding Association counsellor
• doctor

You might find breastfeeding your first baby harder because of inverted or flat nipples. However, it often becomes easier with your next baby.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Are there any complications from having inverted or flat nipples?

Having flat or inverted nipples can make it harder for your baby to attach to your nipple at first. If your baby can’t attach well, this may cause nipple pain or injury.

Your midwife, lactation consultant or child health nurse can help with this.

Some babies may become used to the texture of a nipple shield and find it hard to go back to feeding from your nipple. Your child health nurse or lactation consultant can help wean your baby off the nipple shield. This process may take several weeks.

Resources and support

The Royal Women’s Hospital has a fact sheet on using nipple shields when breastfeeding.

The Australian Breastfeeding Association page offers information on various topics, including:

• the role of a breastfeeding counsellor
• attaching your baby to the breast
• how to hold your baby when breastfeeding
• recognising your baby’s feeding cues

Read more about common breastfeeding questions and problems.

Languages other than English

Health Translations has a fact sheet about breastfeeding in multiple languages.

The Australian Breastfeeding Association provides a guide to breastfeeding in languages other than English.