Flat nipples sit level with the areola rather than protruding outward. They don’t stick out at rest, and they may not become erect in response to cold, touch, or stimulation. This is a normal anatomical variation, not a medical condition. Up to 10% of the population has flat or inverted nipples, and about half of those cases run in families.
Flat vs. Inverted Nipples
The two terms often get grouped together, but they describe different things. A flat nipple sits flush with the surrounding skin. An inverted nipple actually retracts inward, pulling below the surface of the areola. Some flat nipples will temporarily protrude when stimulated or when exposed to cold, while others remain consistently level. Inverted nipples are graded by severity: mild cases can be coaxed out manually, while more severe cases are held in place by shortened milk ducts or tight connective tissue and won’t budge.
Both are common, and both can be present from birth. Your nipples formed during fetal development, and flat or inverted shapes typically result from a small nipple base or milk ducts that didn’t fully elongate. Many people have one flat nipple and one that protrudes normally, or one flat and one inverted.
What Causes Flat Nipples
Most flat nipples are congenital, meaning you’ve had them since birth. The underlying reason is usually structural: the tissue beneath the nipple didn’t develop in a way that pushes it outward past the areola.
Flat nipples can also develop later in life. Pregnancy is one of the most common triggers. As breast tissue swells with milk production, the nipple can flatten against the expanded areola. Breast engorgement after delivery does the same thing, sometimes making nipples that were previously protruding appear temporarily flat. Age-related changes play a role too. As you approach menopause, milk ducts can shorten and pull the nipple inward or flatten it.
Less common causes include breast injuries, mastitis (a breast infection), duct ectasia (widened milk ducts), significant weight loss, and prior breast surgery. Chemotherapy, radiation therapy, and hormone therapy can also change nipple shape.
When New Flattening Is a Concern
If your nipples have always been flat, that’s almost certainly just how your body is built. The situation is different if a nipple that previously protruded suddenly flattens or retracts. A new change in nipple shape can signal an underlying problem.
Breast cancer can cause nipple flattening when a tumor invades a milk duct, pulling the nipple inward. Paget’s disease of the breast, a rare cancer that develops in the skin of the nipple itself, can also flatten the nipple and is sometimes mistaken for eczema because it causes a rash and inflammation. Other warning signs to watch alongside sudden nipple changes include skin dimpling on the breast, bloody or unusual discharge, a new lump, or redness and scaling on the nipple or areola. A nipple that changes shape on one side only deserves prompt evaluation.
Breastfeeding With Flat Nipples
Flat nipples are one of the most common concerns new parents bring to lactation consultants, but they rarely prevent breastfeeding. Babies don’t actually latch onto the nipple alone. A good latch involves the baby taking in the areola and surrounding breast tissue, which means nipple shape matters less than many people expect.
Positioning and Latch
Your body position can make a real difference. Lying on your side or reclining lets gravity pull excess fluid away from the areola, softening the tissue and making it easier for a baby to latch. Sitting upright tends to do the opposite, drawing fluid toward the areola and making the area puffier and harder to grasp. When your baby latches, their mouth should be open wide enough to take in the areola and some breast tissue, not just the nipple tip.
The Stenting Technique
A simple manual trick can help coax a flat nipple outward right before feeding. Place your thumb and index finger on opposite sides of the areola, then gently press down to encourage the nipple to protrude. Offer the breast while keeping your fingers in place for the first 10 to 20 seconds after your baby latches. Once you can see or hear them swallowing milk, remove your fingers. The baby’s own suction will continue drawing the nipple out as they feed.
Nipple Shields
A nipple shield is a thin, flexible silicone cover shaped like a nipple that sits over your areola during feeding. It gives the baby a more pronounced shape to latch onto. Shields are commonly used for flat nipples, sore nipples, premature babies who have trouble latching, and during the transition from bottle to breast. To use one correctly, center it over your nipple and rotate it clockwise to draw nipple tissue into the shield’s tunnel, then stretch the base around the areola. A few drops of water on the edges help it stay in place.
Most people use nipple shields temporarily. Studies report a median use of about 2 weeks, though some mothers use them for several months. The goal is typically to wean off the shield as the baby becomes a stronger, more efficient feeder and as the nipple tissue stretches over time.
Exercises to Draw Out Flat Nipples
A technique called Hoffman’s exercise is the most widely referenced manual method. You place both thumbs at the base of the nipple, press gently into the breast tissue, and then pull your thumbs apart, stretching the tissue horizontally. Repeat the same motion vertically. The idea is that repeated gentle traction gradually loosens the connective tissue anchoring the nipple flat.
Protocols vary, but most call for doing this about 5 times per day for anywhere from 3 days to several weeks. Each session typically lasts a few minutes. The key points are to use gentle pressure, avoid forcing anything, and skip the exercise entirely if the nipple area is cracked, infected, or actively sore. Some practitioners recommend starting during pregnancy, while others suggest waiting until after delivery. Evidence on how well it works is mixed, but it’s low risk and easy to try.
Surgical Correction
For people who want a permanent change in nipple projection, whether for cosmetic reasons or because flat or inverted nipples cause ongoing breastfeeding difficulty, surgical correction is an option. Several techniques exist, including suture-based methods that hold the nipple in a protruding position, small tissue flaps that add structural support beneath the nipple, and procedures that release the shortened ducts or connective tissue pulling the nipple flat.
Some of these procedures preserve the milk ducts, which matters if you plan to breastfeed in the future. Others partially or fully sever them. Recovery is relatively quick for most techniques. You’ll typically be advised to avoid tight or compressive bras for at least two weeks after surgery to let the tissue heal in its new position. Recurrence, where the nipple gradually flattens again, is possible depending on the method used and the original degree of inversion.