Inverted Nipples or Flat Nipples are a common cause of breastfeeding challenges. Women with inverted or flat nipples *can* breastfeed successfully and exclusively, but it may take some extra effort and assistance in the early stages of establishing breastfeeding to ensure success.

How do I know if I have inverted or flat nipples?

Inverted nipples are easier to identify, because the nipples are actually sink in within the middle of the areola (the dark circle at the end of the breast surrounding the nipple). It can be both whole nipples, or it can be just one breast, or only part of the nipple. Flat nipples can be trickier. When I was pregnant with my first, some book told me that if the nipple stuck out when it was cold or when stimulated, then they were not flat. Seeing as how I *did* have flat nipples, that was fairly lousy information, because without any sense of degree (of sticking out, that is), that test can be misleading.

After a combined 3+ years of nursing my two daughters, I no longer have flat nipples, and I can tell you that if you aren't *sure* that you don't have them, I'd talk with a lactation consultant, Le Leche League leader or other nursing mother who can take a look or show you what non-flat nipples look like.

Why do I need to know if I have inverted or flat nipples?

Inverted nipples or flat nipples can make it more difficult for a newborn baby to latch on properly to your breast. Without assistance, this can lead to early failure of breastfeeding due to giving up from frustration, insufficient supply due to poor stimulation, or increased pain due to incorrect latch. Take heart that some babies are instinctively excellent nursers who will just latch on and go to town, despite flat or inverted nipples – but women with these conditions are more likely to have challenges than those without.

Should women with flat or inverted nipples "prepare" their breasts for nursing?

There is some debate about this. For the most part, I think no, although if you look around you will find differing opinions. I was not screened for flat nipples prior to the start of breastfeeding difficulties with my first daughter, so I don't have personal experience with trying to fix the issue during pregnancy. (If you did, and had success with this, I'd love to hear about it in the BellaOnline Breastfeeding Forum). However, even after trying many interventions to help, and finally establishing nursing and milk supply with the help of a nipple shield and a pump (see my articles on Nipple Shields and Increasing Low Milk Supply, in Related Links at the end of this article), I found that it took many months of constant nursing and pumping before I even began to see a change in the nipple shape. The nipple would protrude immediately after nursing or pumping (although nothing like that of the women in breastfeeding group with "normal" nipples!), but would always sink back in a little while after feeding.

When my daughter finally was able to latch properly without the nipple shield, it was not because the nipples were protruding in the regular way at the start of feedings, but simply because she had become such an expert nurser and latcher that she no longer needed them to do so! If it took more than 4 months to begin to correct for me with the nursing and pumping, I find it unlikely that intermittent "treatment" during or before pregnancy could make much of a permanent difference. You also want to be very, very careful about creating any nipple stimulation, especially through pumping or otherwise pulling on the nipple, while pregnant without the advice and supervision of your doctor or midwife. Nipple stimulation can cause contractions or in extreme cases, preterm labor.

What I *would* do if you know or suspect you have flat or inverted nipples is to find a breastfeeding counselor or professional near you that can talk you through some possible interventions that may help, help you to understand how to establish a healthy milk supply (even if the baby isn't latching properly) and ideally, be available to support you through any challenges through first few feedings, few days or few weeks.

For more information on what *can* be done to help establish successful breastfeeding with inverted nipples or flat nipples, see my article, "Breastfeeding with Inverted or Flat Nipples," in the Related Links below.

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