Inverted nipples: what they are and how to manage them during breastfeeding

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Inverted nipples are a quite common condition in which the entire nipple points inward instead of outward. Both men and women can have this condition, on one or both nipples. It is also possible to have only nipple retraction, meaning only part of the nipple turns inward.

Generally, this condition is only an aesthetic issue and does not cause any medical complications. However, some women with inverted nipples may have difficulty breastfeeding. Just observe: if the nipples have always looked like this, it does not represent a medical condition that needs treatment. But if the problem has arisen recently, then it could be a symptom of neoplasia. But let's proceed in order.

How to tell if you have inverted nipples

A distinction is necessary: flat nipples do not protrude from the areola (the darker area surrounding them), even when stimulated, while an inverted nipple points inward and does not protrude, even when stimulated. If you're unsure whether your nipple is inverted, try the pinch test: gently compress the breast with your thumb and index finger on both sides of the areola. Most nipples will protrude, but if yours retracts inward, creating a hollow, then it is inverted.

What are the causes of inverted nipples?

Inverted nipples are often congenital, meaning they are present from birth. This condition can result from milk ducts that do not develop fully and typically does not require treatment, as it does not represent a pathology.

On the other hand, if they occur in adulthood, this condition is known as acquired nipple inversion or retraction. Its causes, which range from mild to severe, may include:

  • Breast cancer, which can include a rare form known as Paget's disease of the nipple.

  • Fibrocystic breast disease

  • Duct ectasia of the mammary duct, which involves widening of a milk duct and thickening of the walls, resulting in obstruction of the lactiferous duct.

  • Scarring or fat loss in the area due to trauma or surgical procedures.

  • Periductal mastitis: inflammation and infection of an obstructed milk duct, often caused by duct ectasia.

Inverted nipples: when should you see a doctor?

In some cases, inverted nipples can make breastfeeding a real challenge; in rare cases, they can be a sign of breast cancer.

Inverted nipples and breastfeeding: a possible challenge

With inverted nipples, breastfeeding is often still possible. Remember that newborns do not latch only onto the nipple, but onto a larger portion of the breast , which also includes part of the areola. In the very first days of life, when your baby's mouth is still tiny and not yet trained, sucking might be less effective, as the nipple may not fulfill the role of stimulating the palate and triggering the sucking reflex. This can lead to problems latching onto the breast or latching on and then immediately detaching, which can hinder the transfer of milk from the breast to the baby's mouth.

How to prepare the nipple during pregnancy?

As the months of pregnancy go by, you might notice that your nipples start to protrude on their own . Otherwise, you can use nipple shapers , soft and flexible silicone disks that discreetly fit inside the bra and apply gentle pressure to the nipples, helping them protrude. They can be worn starting from the thirty-second week of a low-risk pregnancy, beginning with one hour a day and gradually increasing to up to eight hours.

In case of risk of preterm labor, the use of these devices should be agreed upon with a doctor, as nipple stimulation can cause contractions

Postpartum, you can continue to use nipple shapers by wearing them from 30 to 60 minutes before breastfeeding .

How to help the baby latch onto inverted nipples?

If your baby seems to suck on a finger but does not seem interested in the breast, it may be a sign that the nipple is not reaching the palate when latching on. In that case, there are various techniques you can use just before each feeding to give the nipples a more protruded shape and help your baby latch onto the breast. Here they are:

  • pinch the nipple between the thumb and index finger to encourage it to protrude

  • compress the breast just behind the areola with your fingers in a "V" or "C" shape to push the nipple outward

  • rub the nipple with a cold compress or an ice cube to achieve an erection

  • manually extract the nipple or use a breast pump for a couple of minutes before a feed

  • use a nipple shield, a thin and flexible silicone device shaped like a nipple, with holes at the tip to allow milk to pass through. Its shape is designed to stimulate the palate and promote sucking. As breastfeeding continues and milk production increases, the nipple shield may no longer be necessary.

How to breastfeed with a nipple piercing?

The nipple piercing must be removed before breastfeeding, as it poses a choking hazard to the baby and could also hurt the tongue, gums, or palate while sucking. The impact on the ability to breastfeed depends from person to person : for many women, the nipple becomes more sensitive; others experience milk leakage from the hole created by the jewelry; still others believe that the piercing scar obstructs the flow of milk. In these cases, it is advisable to be guided by a midwife or a doctor.

Taking care of your inverted nipples

Inverted nipples may require more care compared to a typical nipple, as your baby might suck more vigorously, causing more pain during feeding. Additionally, after feeding, it is important to remember to clean and dry them well to reduce the risk of infections, including thrush.

And if you can't breastfeed with inverted nipples?

If you have tried everything and breastfeeding doesn't work, the most important thing is that your baby is fed. So, you can try feeding with formula milk or using an electric breast pump .

Useful tips for breastfeeding with a flat nipple

STIMULATE THE NIPPLE






La tecnica Hoffman:

  1. Place your index finger and thumb on both sides of the nipple.

  2. Press your fingers firmly into the breast tissue.

  3. Gently stretch the areola in all directions.

  4. Repeat five times every morning (if the process is painless).

CHECK THE DIAPER


HAND SPREAD

If the breast is very swollen with milk and hard, the nipple may flatten. Expressing a little milk by hand can soften the breast so that the baby can latch on more easily.

How do you do it?

  1. With one hand, grasp the breast; with the other, form a "C" shape with your thumb and index finger near the areola, but not on it.

  2. Gently squeeze and release the pressure.


Frequently Asked Questions

Frequently asked questions

How many people have inverted nipples?

Approximately 10 - 20 % of women are born with recessed nipples.

How to breastfeed if the nipple is inverted?

Here are some helpful tips: Pinch the nipple between your thumb and index finger to encourage it to protrude; Compress the breast just behind the areola with fingers in a "V" or "C" shape; Rub the nipple with a cold compress or an ice cube; Manually extract the nipple or use a breast pump for a couple of minutes before a feeding; Use a nipple shield, designed to stimulate the palate and promote sucking.

How to tell if I have flat or inverted nipples?

Contrary to what one might think, to determine if you have an inverted or flat nipple , it is not enough to observe it; instead, it is necessary to press the areola with your fingers from both sides (away from the nipple). If the nipple does not protrude, then it means it is flat, while if it retracts into the breast, it is inverted.

Can flat nipples become erect?

It can occur during pregnancy and in the first week after the baby's birth. Breastfeeding with flat nipples is possible, it just takes a little more time and patience.