Women with inverted or flat nipples can breast-feed. Breast-feeding experts disagree on whether pregnant women should be screened for flat or inverted nipples, and whether treatments to draw out the nipple should be routinely recommended.1 The following approaches can be taken.

Preconception/antenatallySuction devices may offer permanent nipple correction,2 but are not a prerequisite if the woman plans to breast-feed. These devices need to be used regularly (for up to 8 hours at a time), pre-pregnancy or in the first and second trimesters, if the woman is seeking permanent nipple correction.

PostnatallyMothers can stimulate nipples before feeds by rolling them between the thumb and index finger and applying a moist cold cloth. Expressing milk onto the nipple also encourages infant suckling. Applying suction (using a pump or specialist suction device immediately before each feed) offers effective non-surgical correction of inverted nipples and triggers the let-down reflex; this is a good way to establish breast-feeding in women with inverted or flat nipples. Alternatively, breast shells may be worn immediately before feeding or for a few hours or during the day whilst not feeding: they draw out the nipples by exerting pressure around the areola. Occasionally, while breast-feeding is being established, using a nipple shield may help the baby to latch on, by drawing out the nipple, although there is little clinical evidence to support this approach.1

References1. The MAIN Trial Collaborative Group. Preparing for breast feeding: treatment of inverted and non-protractile nipples in pregnancy. Midwifery 1994; 10: 200–214.

2. McGeorge DD. The "Niplette": an instrument for the non-surgical correction of inverted nipples. Br J Plast Surg 1994; 47: 6–49.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6). http://www.jfhc.co.uk/images/stories/breastfeeding.pdf