TREATMENTS TO DRAW OUT A FLAT OR INVERTED NIPPLE
While it's very important to remember that most babies who latch-on well can draw out even an inverted or flat nipple, and that a baby does not "nipple-feed", there are several possible options for treating a flat/inverted nipple that may make latch-on easier for the baby. Some of these treatment measures can be employed before birth and others will want to be delayed until the baby arrives. Still others can be used as treatment options both during pregnancy and after breastfeeding has begun.
* Breast shells. Breast shells, also referred to as milk cups, breast cups, or breast shields, take advantage of the natural elasticity of the skin during pregnancy by applying gentle, but constant pressure to the areola in an effort to break the adhesions under the skin that prevent the nipple from protruding. The shells are worn inside the bra, which may need to be one size larger than normal to accomodate the shell. Ideally, shells should be worn starting in the third trimester of pregnancy for a few hours each day. As the mother becomes comfortable wearing the shells, she can gradually increase the amount of time she wears them during the day. After the baby is born, these same shells can be worn about 30 minutes prior to each feeding to help draw out the nipple even more. They should NOT be worn at night and any milk collected in them should NOT be saved.
* Hoffman Technique. Doing this technique several times a day may help loosen the adhesions at the base of the nipple. To employ this technique: place a thumb on each side of the base of the nipple - directly at the base of the nipple, not at the edge of the areola. Push in firmly against your breast tissue while at the same time pulling your thumbs away from each other. By doing this you will be stretching out the nipple and loosening the tightness at the base which will make the nipple move up and outward. This exercise should be repeated 5 times a day, moving the thumbs in a clockwise fashion around the nipple. It can be used during pregnancy and after baby begins breastfeeding.
* Breastpump. After birth, the use of an effective breastpump can be helpful at drawing out a flat or inverted nipple immediately before breastfeeding to make latch-on easier for the baby. It also can be used at other times following delivery to help further break the adhesions under the skin by pulling the nipple out uniformly from the center.
* Evert-it Nipple Enhancer. Available through La Leche League, this device helps to draw out the nipple by providing uniform suction similar to that obtained with a breastpump.
* Nipple stimulation. After birth, if the nipple can be grasped, a mother can roll her nipple between her thumb and index finger for a minute or two and then quickly touch the nipple with a moist, cold cloth or ice wrapped in cloth (avoid prolonged use of ice as it can inhibit the letdown reflex and numb the nipple too much).
* Pulling back on the breast tissue at latch-on. As you support your breast for latch-on with thumb on top and four fingers underneath and way back against the chest wall, pull slightly back on the breast tissue toward the chest wall to help the nipple protrude.
* Nipple shield. ONLY TO BE USED AS A LAST RESORT, the nipple shield is a flexible nipple made out of silicone that is placed over the mother's nipple during feedings so that latch-on is possible for the baby. To prevent the baby from becoming too addicted to nursing with the shield, it should be removed as soon as the baby is latched-on and nursing well. The length of time during the feeding that the shield is used should also be steadily decreased. Possible problems associated with the use of nipples shields include a drop in the mother's milk supply and insufficient transfer of milk to the baby. Because of these possible risks, it is strongly recommended that you only use a nipple shield under the direct supervision of a lactation expert such as as a lactation consultant or La Leche League leader. It should be noted, however, that even with the possible risks of using a nipple shield, as long as the mother is aware of what to watch for, breastfeeding with a nipple shield is much more preferable to not breastfeeding!