Think you have unusual nipples or strange nipples? We all have different nipples, nobody is the same, and not everybody has those so-called perfect breasts and nipples.
Most of the time, nipple variations will not cause a breastfeeding problem, but there are a few types of nipples and nipple differences that may cause some difficulty.
Mothers with different nipple problems, will need to take extra care that they have a good latch, to prevent nipple pain.
Common Nipple Variations
Normal nipples are a little raised when not stimulated or erect. There are many different shapes, sizes and colors. One breast may also have a larger and differently shaped nipple to the other. Sometimes the different variations may cause some breastfeeding problems, but most of the time, a mother can still breastfeed.
Flat nipples do not protrude when at rest and when stimulated they might only protrude a little. A mother with flat nipples, who breastfeeds, usually notices that her nipples protrude more over time, due to the stretching of the nipple. Flat nipples can make it very difficult for a baby to latch onto, but it is possible.
Some mothers who previously had normal nipples, may notice that their nipples are flatter directly after birth. This may be caused by IV fluids, which are given with anesthesia drugs such as Oxytocin, Pitocin or Syntocinon. The flatness of the nipples can also be caused by extra water retention owing to Pre-eclampsia.
A mother can massage her breasts and make use of nipple stimulation just before feeding to make an erect nipple for baby to latch on to.
Long or Extra Large Nipples
Some of the
longest nipples are 2cm or more. Some of the biggest nipples are 2.5cm
in diameter and bigger. Usually a large or long nipple will not cause a
breastfeeding problem, unless the oversized nipples are badly misshapen
Extremely long nipples may cause the baby to gag while
breastfeeding, but this gets better as the baby gets older. Read more about breastfeeding with large, thick nipples here.
Double Nipples and Bifurcated Nipples
ladies may have more than one nipple on the areola. A second or third nipple may
or may not produce milk. The extra nipple may get in the way while
breastfeeding, but usually does not cause problems.
A Bifurcated nipple is a nipple with one or more separations; it is slit into two or more parts. A
bifurcated nipple does not generally hinder breastfeeding.
folded nipple usually shows as a slit. The nipple is folded inwards.
This can cause some discomfort, if the two sides of the folds rub against
each other whilst breastfeeding.
A nipple piercing should not affect a woman’s ability to breastfeed. The mother should take the nipple ring out, if it is causing problems. If she decides to leave it in, she should make sure that it is secure, so that her baby cannot choke on it.
Nipples that Appear Inverted
These types of nipples are also called "pseudo-inverted nipples," "retractile nipples," or "umbilicated nipples,"
nipples are only inverted when at rest, but become erect when stimulated
or cold. This type of nipple only looks inverted and should not
contribute to any problems while breastfeeding.
These nipples are normal when at rest, but become inverted when stimulated or when pressure is put on the areolae. Some mothers with retracted nipples might only notice a slight retraction, while others have nipples that retract completely. This problem is usually lessened with each pregnancy and with breastfeeding; with hormones and stretching of breast tissue.
True Inverted Nipples
called “invaginated nipples". These types of nipples are drawn inwards
while at rest and when stimulated. This happens, because the internal
adhesion inside the nipples are keeping the nipple tied down.
inverted nipples are rare and some mothers only have one inverted nipple,
while the other is normal. Some women think they have inverted nipples,
when they actually have inverted appearing nipples, which become erect
Read more about how to breastfeeding with flat or inverted nipples.
A rare congenital anomaly
occurs when a woman does not have nipples or nipple pores.
Breastfeeding in this case is impossible, unless only one breast has
Treatment and Advice
- Massage the breast to bring the nipple out (used for flat nipples) Nipple massage just before nursing, can also help make flat nipples more erect for breastfeeding.
- Shape the nipple and breast with the hand. If the mother cups her breasts in a C hold and then gently presses towards her chest wall, the nipple should protrude more.
- Pumped nipples: A breast pump can be used to pull the nipple erect, just before a breastfeeding session.
- A nipple enhancer “nipple extender" or syringe can be used to draw the nipple out just before a feeding. The Lansinoh latch assist, is a little device that can help pull a nipple out just before a breastfeeding session.
- A little nipple stretcher device called the Niplette (Avent), is made especially for the purpose of stretching out the nipple. Nipple stretching is done during pregnancy, to stretch the nipple out before the baby arrives.
- Compressing the areola: This is usually done when the mother has fluid retention. Gentle pressure with the thumbs at the base of the nipples until an indentation occurs, then the same is done further up until at the rim of the areola. This can also cause a let down, which could help a baby latch on quicker.
- Reverse pressure softening: same method as above, except 3 to 4 fingers are used on each side of the breast. This also helps soften the breast and causes a let down.
A nipple shield: A silicone nipple shield can be used for flat or inverted nipples, if none of the other techniques work. Read more about using nipple shields here.
- Continue to breastfeed: many mothers find that even after weaning, their nipples stay drawn out. The sucking action stretches the tissues.
- Nipple enlargement: Doctors can now loosen adhesion's of the nipple to fix inverted nipples.
As a last resort, if your baby struggles to breastfeed on only one of your breasts, you can continue to breastfeed from just one breast. If your baby struggles to breastfeed from both breasts, you can consider pumping exclusively. Please read more about breastfeeding from one breast and exclusive pumping.
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Tracy Behr, CBC, CLD (CBI)
Course information on physiology of lactation / breastfeeding problems / nipple variations.
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