Flat Nipples

  • Have inverted nipples or flat nipples been a problem in the past to nursing a baby? Maybe it is only a cosmetic concern; either way, you will find help here!!! While inverted nipples may not be as common as flat nipples, it still affects many men and women.

    It is best for treatment to start at puberty, but individuals of any age can find help for this delicate problem. If the inversion is not genetic, please see your physician to rule out any more serious causes.

     Many physicians do not know about the treatments available except for surgery,  nor do they discuss the inversion with their clients. To them, it is a variation of normal and since they have very little information to share, it is ignored. They may question if the inversion is congenital verses something that has recently occurred. If it is congenital, they will usually not be concerned.

    It would be great if all obstetricians did thorough exams of nipples on all pregnant women on the first visit, and adolescents on their first GYN visit, but since they rarely assess for flat or inverted nipples, it can be done by the individual!

    How do you determine if you have flat or inverted nipples?

    It will be obvious on many people just by looking at the nipple....if it doesn't protrude or does in fact stay hid inside, then it would be considered flat or inverted.

    If your nipples appear normal, but retract when stimulated, they could still pose breastfeeding difficulties. Do a simple test to determine if your nipples are inverted or flat:  place your thumb and index finger on the areola and compress. If the nipple retracts or inverts into the breast, then treatment may be needed before breastfeeding.

    Babies are suppose to breastfeed, not nipple- feed, so some women will have no difficulty nursing a baby with flat or inverted nipples especially if their nipples can elongate easily due to good elasticity. Many times after nursing, the nipples will be corrected from the baby nursing, especially if the mother nurses for years instead of months.

    Since I have assisted women with breastfeeding that have had flat or inverted nipples that did pose a problem with the baby latching on effectively, or they did experience needless pain with breastfeeding, I strongly recommend treatment before pregnancy. If it isn't done before pregnancy, then it should be started ASAP.

    What treatments are available for flat or inverted nipples and how effective are they?

    • Cosmetic surgery- This option is expensive, can impair the ability to breastfeed and is often not permanent. I've had contacts with many people where the surgery didn't last...some as soon as two months post op; and others within the first year had their nipples invert again.
    • Niplette- This is the most aggressive treatment available for inverted or flat nipples and the only treatment designed for permanent correction  besides surgery with less expense and without invasion. The Avent Niplette is usually recommended by Plastic surgeons before they consider doing surgery.  They have been used my men and women with great success for correcting cosmetically and for breastfeeding purposes. They can help minimize painful nursing if worn during pregnancy. They can also increase the likelihood of a successful surgery if worn after the healing process from cosmetic surgery for correcting inverted nipples. (If used after surgery, this must be approved by your plastic surgeon.) The Niplette uses gentle suction to pull the nipple into a small plastic thimble-like cup and is worn this way for at least eight hours at a time. Please click here to order the Avent Niplette.

      More Information on the Avent Niplette

      Helpful Suggestions for Using the Avent Niplette

      Instructions on use of the Avent Niplette

    • Breastpumps- This can be used before trying to latch the baby on to the breast, but many times, the nipple will invert so quickly, it takes a while before it will stay out well and stretch the tissue. (Not as effective as wearing the Niplette during or before pregnancy, or wearing the Niplette before latch on.)

    • Evert-It Nipple Enhancer- This consist of a syringe with a soft, flexible tip made of silicone. Suction is used to help the nipple protrude to facilitate latch on.

    • Breast Shells- These are cups worn inside the bra over the breast that have a small hole in the center to allow the nipple to protrude through, thus helping to stretch underlying tissue and to draw out the nipple. How effective is this? Studies have shown no benefit and my personal experience is that is has helped, but only for a very few.

    • Hoffman Technique- Consist of exercises using your thumbs that attempt to loosen adhesions, but no research proves this to be effective.

    Medela Hobbit Shells- disadvantage: They have a hard back and are small, so they show through clothing. Advantages: lower cost
    Medela Soft Shells- advantages: rubber backing for comfort, larger & rounded for natural looking appearance. disadvantage: more expensive
    Avent Isis Comfort Breast Shells- These are not designed for inverted nipples, but the cone shape would do the same job as the Hobbit Shells. It features a very soft silicone backing with the same petal massagers that come with the Isis Breastpump. Since they apply gentle pressure on the areola to help alleviate engorgement, they can help the nipple to protrude as well. Advantages: They come with 2 sets of Shells; one for sore nipples between breastfeeding and one set with backing that has no ventilated holes so that the precious liquid GOLD can be saved and stored for later use. If worn early in breastfeeding, have shown to increase milk supply. Disadvantages: The prongs on the shells used to keep them standing upright when used for milk collection, can show through tight clothing.
    Ameda Breast Shells 


Phone: (256) 557-5144


          Lactation Consultant Marsha Bearden


Marsha Bearden is from Crossville, Alabama (located in Northeast Alabama in scenic DeKalb County).  She is a Registered Nurse and mother of three beautiful breastfed children.  She maintains a current certification as a Lactation Consultant.  She specialized in Maternal Child Nursing in a hospital setting for fourteen years, with eight years as a charge nurse on the Obstetrical Unit.  She developed and managed the Lactation and Childbirth Education Programs at Dekalb BMC in Fort Payne, Alabama.  In 1999, she entered into her own private practice. She has had extensive experience counseling breastfeeding mothers since 1985 and is currently a member of the Alabama Breastfeeding Coalition. .