How Nipple Shapes Can Impact Breastfeeding

Adriana Lozada: Hello, mighty parent and parent to be. I’m Adriana Lozada and you’re listening to Birthful. And just like every other week, I’m going to take about 10 minutes or so to dive deep into a topic you need to know about. And this week it’s one that doesn’t get talked about much, which is breast and nipple shapes. Now about 10% of females will have at least one nipple that can be classified as flat or inverted. And that can sometimes, not always, make it more challenging to feed. So we’re going to be talking about how you can determine if your nipple shape may make things a bit more difficult when it comes to breastfeeding. But I do want to preface that this doesn’t mean that something is wrong with your anatomy. I know that as a society, we already tend to be super critical of our bodies. And so I invite you to consider your nipple shape and breast size as a variation of normal, without judgment, or at least minimizing the judgment as much as you can.

Also, as you know, I am a big fan of knowledge and preparation. And so I hope that learning about all this today is going to give you a heads up and help minimize potential obstacles and just make your experience a bit easier. Okay. So then let’s start with, why do nipple shapes matter at all if we know that, as the saying goes, babies don’t nipple feed, they breastfeed. And so the thing is that babies need to latch onto all of it. Nipple and areola get a good mouthful of breast. Most babies can generally breastfeed on flat nipples, but some may have difficulty latching on because they may need the sensation of something deeper in their mouths triggering that sucking reflex so that then they can pull the nipple toward the back of their mouths into that junction between the hard palate and the soft palate. If you find that your baby can latch on or feed and is gaining weight, then you don’t have to worry at all about your nipples.

They’re working, everything is good, doesn’t matter what shape they are. But if your nipples don’t protrude enough, then that’s where things can become more challenging. So first let’s figure out what you have. If your nipples stick out and become erect when stimulated or cold, then they’re neither flat nor inverted. And if that’s not so much the case, you can do what’s called a pinch test to determine if your nipples are flat or inverted. And this is done by gently compressing your areola about an inch behind your nipple.

If the nipple does not become erect, then it’s considered flat. And if it retracts or turns inward, then it’s considered inverted. Even with flat or inverted nipples, there may be some degree of protrusion, which is why most babies are not going to have a problem latching on. And then the repeated stimulation while feeding, that sucking, that pulling, is going to help the nipple extrude more and make it an easier process as time goes by. Then also in general, and for everyone, if the breasts are engorged or over full, it may make it more difficult for the baby to latch on because the nipple is less supple for them to get a good mouthful and pull it inside their mouths.

So in this case, massaging the breast or expressing some milk to release the pressure can make it so that any baby can then latch easier. Make sure though that you feed them or save that expressed milk. Now, if you’ve determined that you have flat or inverted nipples, then right before feeding, you can help draw the nipple out via manual stimulation or priming the nipple with a manual pump or even using a cold washcloth for a quick moment. Sometimes simply the act of your baby suckling will do the trick. Now during feedings, try different positions and try even using a C hold to help the nipple protrude.

For this, you make a C with your hand, with the C being between your thumb and your pointer finger. And then you squeeze the breast about an inch behind the areola. So make sure your fingers are not grasping the areola so that they’re not in your baby’s way as they try to latch. Because in some cases, depending on where you hold, for some people the nipple can invert. Practice doing that C hold beforehand, just in front of a mirror, to see what your nipples do. Using laid back feeding positions that encourage biological nurturing and intuitive deep latching can also be helpful to have your baby go deeper into your breasts and have a deeper latch.

Do have lots of patience as you both figure it out and know that if you or your baby are becoming frustrated, then take the time to calm both of you down before trying it again. Also, if it’s painful at any point, unlatch your baby and try again. In some cases, feeding with a nipple shield may also be helpful. Just use it as a transitional tool, not a final destination. And you’ll probably find that as your baby latches more and more, your nipples will often stick out more and more over time, making everything easier. Now, when you’re not feeding your baby, you can also help extrude the nipple by using a gentle suction device like what’s called a nipple extractor or a latch assist device that creates a light vacuum around your nipple to help it protrude more and more over time.

And then you can also use these devices during pregnancy, but since your body is changing so much during pregnancy and your tissues are gaining elasticity, your nipples may protrude more on their own, so it may be worth waiting until a month or two before your expected date of delivery to start using any device. Whatever the case, I highly recommend reaching out to a lactation consultant to determine the best course of action and guidance on how to use these devices if you’re going to use them. Now, let’s say that you don’t have inverted or flat nipples, but what you have are large nipples. This may be a challenge initially, if you have a preemie or if your baby has a small mouth. Because in order to breastfeed, they need to get all the nipple and enough of the areola in their mouth to compress the milk ducts. As your baby grows and has more head control and can open the mouth wider, that’s going to get easier. And the truth is that most healthy, full term babies can latch onto large nipples, no problem.

If you’re finding that you’re having some difficulty, try out different ways of holding your baby, like using a football hold or what is called a dancer hand. I can’t quite describe that over the audio, but ask your lactation consultant about these options or google them. Now, let’s say that what you have are large areolas. Since babies usually get about an inch of areola in their mouth when they’re feeding, if your areolas are larger, meaning more than two inches across, then it can be hard to determine how much of the areola they have in their mouth and if they are indeed getting more than just the nipple. You’ll certainly figure this out with practice or with the help of someone versed in lactation, hint, hint, lactation consultant. But it can also be helpful to look at your other areola as a reference when you are feeding your baby to see how much of the areola that they’re latched onto, how much of that is missing, meaning how much of it is in their mouth.

Now I’ve talked a lot about nipples and areolas, but I also wanted to touch upon breast sizes. The bottom line is the size of your breast does not determine your ability to breastfeed. And if you have experienced any sort of breast changes during pregnancy, then you should be good to breastfeed. And if you haven’t experienced any changes, then definitely reach out to a lactation consultant. Depending on your breast size, some positions are going to work better for you and your baby than others. So try different ones. Try to figure out what fits you better, and then know that these positions are going to evolve as you both learn more of how you breastfeed and your baby has more control over their body. Now, if you have very large breasts and a small baby, you may have to support your breasts a bit more so that gravity isn’t shifting the latch and your baby can hold on to that latch better.

Also, please remember that nipples and breasts are only one part of the equation. Your baby’s ability to breastfeed is incredibly important. So things to consider are, can they open wide, meaning like they’re taking a big yawn? Or do they have a well-coordinated suck? Are there other things making the latch more challenging, like some tether oral tissues, meaning lip ties or tongue ties or buccal ties? Or do they have a recessed chin or maybe some asymmetrical tightness around their neck and jaw from challenges and different pressures getting through the birth canal? And even more importantly, can you identify what a good latch looks like? And if not, learn about it, take a class, observe other friends breastfeeding or watch some videos. Even drop into a breastfeeding support group during pregnancy. Because the thing is a not great latch can lead to sore, blistered or cracked nipples, even in one session.

And then over time it can affect milk supply. So a great idea is to reach out to a lactation consultant right now, and then get assessed. Have them come up with a plan for you. This is also going to give you time to mentally process the possible challenges that you might have and prepare for them. Do have your lactation consultant on speed dial after the baby is born to help figure out how to navigate any new challenges that may come up. And truthfully, this is helpful for anyone regardless of breast size or nipple shape. You can connect with Birthful on Instagram, @birthfulpodcast. And to learn more about Birthful and my birth and postpartum preparation classes, go to birthful.com. 

Birthful was created by me, Adriana Lozada, and this episode was produced by LWC Studios: Paulina Velasco, Jen Chien and Kojin Tashiro. Thank you for listening to and sharing Birthful. Be sure to follow us on Apple Podcast, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.

CITATION: 

Lozada, Adriana, host. “Birthful: How Nipple Shapes Can Impact Breastfeeding.” Birthful, Birthful, February 23, 2022. Birthful.com.