Pumping with inverted nipples is often highly successful, providing an effective method for milk expression when a direct latch may be challenging. An inverted nipple retracts inward or lies flat against the areola, usually due to shortened milk ducts or underlying fibrous tissue tethering the nipple inward. The breast pump’s vacuum action can work as a temporary eversion tool, drawing the nipple out and making milk transfer possible. This article offers practical strategies for comfort and efficient milk expression.
Understanding the Types of Inverted Nipples
The degree of nipple inversion is classified into three grades based on how easily the nipple can be manipulated. This classification helps understand the physical resistance the tissue offers to eversion. The underlying cause is generally a lack of supportive connective tissue or restriction from short lactiferous ducts.
Grade 1 is the mildest, where the nipple can be easily pulled out with gentle manipulation and maintains its eversion for a short period. Grade 2 inversion allows the nipple to be pulled out, but it quickly retracts inward once stimulation is removed. This grade involves a moderate amount of fibrous tissue tethering the ducts.
Grade 3 is the most severe, characterized by nipples that cannot be pulled out at all, even with strong manual stimulation. This level indicates significant fibrous tissue and severely shortened milk ducts. Regardless of the grade, the potential to produce a full milk supply is not limited by the nipple’s shape.
Essential Pumping Techniques and Setup Adjustments
Achieving a comfortable and effective pumping session begins with meticulous attention to the equipment setup. For inverted nipples, the correct flange size is crucial and may differ from standard recommendations. Measure the diameter of the nipple base and select a flange 0 to 3 millimeters larger to allow the tissue to be gently drawn into the tunnel.
The goal is to ensure only the nipple is pulled into the flange tunnel, not the surrounding areola. Before attaching the pump, gentle manual stimulation encourages eversion. Try rolling the nipple between your fingers or applying a cold compress to help the tissue protrude momentarily.
When starting the pump, use the lowest vacuum setting possible to initiate suction and gradually increase it only to the point of comfort. Pumping should never be painful; high suction levels can cause tissue damage and swelling. Employing double pumping, where both breasts are expressed simultaneously, maximizes efficiency and promotes a greater release of prolactin, supporting milk supply.
Specialized Tools for Achieving Nipple Eversion
Several specialized aids can temporarily draw out the nipple tissue before or during a pumping session. Nipple shields are thin, flexible silicone pieces worn over the nipple and areola. For pumping, a shield helps create a better seal with the flange and provides a stable surface for the vacuum to act upon.
Another tool is the breast shell, a hard plastic cup worn inside the bra between pumping sessions. These shells apply consistent, gentle pressure to the areola, encouraging the nipple to protrude gradually throughout the day. Remove the shells frequently to allow the skin to dry and prevent excessive moisture buildup.
Specific suction devices, often called nipple correctors or latch assists, are also available. These are typically small, syringe-like tools or bulbs that use targeted negative pressure to gently pull the nipple outward right before attaching the pump. While these tools offer temporary eversion, their use should be reviewed with a lactation professional to ensure proper fit and monitor milk transfer.
Managing Pain, Supply, and When to Consult a Professional
Initial discomfort is common, as the pump’s action works to stretch the fibrous tissue responsible for the inversion. This soreness often subsides as the tissue adapts over the first few weeks of consistent pumping. Persistent or sharp pain is a clear indication that the flange size or suction level needs immediate adjustment.
Inverted nipples do not impact the body’s ability to produce milk, but difficulty with effective milk removal can sometimes lead to concerns about supply. Maintaining a schedule of frequent, efficient pumping is the most reliable way to establish and protect a full milk volume. Double pumping and gentle breast massage during the session enhance milk flow and complete breast drainage.
Seek guidance from a certified lactation consultant if you experience persistent pain that does not resolve after adjusting your technique or equipment. Other indicators for professional consultation include skin breakdown on the nipple or areola, or any signs of mastitis, such as a painful lump, redness, or fever. Success with inverted nipples is individualized, requiring patience and a willingness to try different techniques.