Nipple variations (nipple types)
Think you have unusual nipples or strange nipples? We all have different nipples, nobody is the same, and not everybody have 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 my cause some difficulty…
Moms with different nipple problems, will need to take extra care that they have a good latch, to prevent nipple pain.
Common nipples (The norm)
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 mom can still breastfeed.
Flat nipples do not protrude when at rest and when stimulated they might only protrude a little. A mom 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 hard for baby to grasp onto the nipple for breastfeeding, but it is possible.
Some moms, who previously had normal nipples, may notice that their nipples are flatter directly after birth. This is caused by using 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 mom 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 (deformed).
Extremely long nipples may cause baby to gag while
breastfeeding, but this gets better as baby get older. Read more on
breastfeeding with large, thick nipples here.
Double nipples and Bifurcated nipples
Some 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.
A 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 wile breastfeeding.
A nipple piercing should not affect a woman’s ability to breastfeed. Mom 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 baby cannot choke on it.
Nipples that appear inverted.
These types of nipples are also called "pseudo-inverted nipples," "retractile nipples," or "umbilicated nipples,"
These 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 moms 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
Also 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.
True inverted nipples are rare and some Moms 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 when stimulated.
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 this abnormality.
• 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 Mom 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. A little nipple stretcher device
called the Niplette (Avent), is made specially for this purpose. Nipple
stretching is also sometimes done during pregnancy, to stretch the nipple out before baby arrives.
the areola: This is usually done, when Mom 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 baby latch on
• 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 on using nipple shields here.
Continue to breastfeed: many Moms 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 baby struggles to breastfeed on only one of the breasts, Mom can continue to breastfeed from just one breast. If baby struggles to breastfeed from both breasts, mom can start pumping exclusively. Please read more on breastfeeding from one breast and exclusive pumping.
Tracy Behr, CBC, CLD (CBI)
Course information on physiology of lactation / breastfeeding problems / nipple variations.
Other pages on breastfeeding problems in connection with this page on nipple variations
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