NOTE:  The author of this article is not a doctor;  nor is anybody connected with this 
website a doctor.  The below should not be considered as medical advice.




Larry McMahan's Flat/Inverted Nipple F.A.Q.

by [email protected]


I have posted this FAQ on numerous occasions in both
misc.kids.pregnancy and misc.kids.breastfeeding.
I have received a number of responses thanking me for raising
consciousness about this possible problem.

I have also received questions asking whether nipple stimulation
could cause pre-term labor.

The kind of nipple stimulation described in this article is
less intense than, for example, orgasm from engaging in sex
while pregnant.  It is generally accepted medical practice
practice NOT to contraindicate sex during pregnancy.  For that
reason, it is my opinion that there is no more reason to
contraindicate the techniques I describe for correcting flat
or inverted nipples.

If pre-term labor has been identified as a preexisting
problem or if you have a condition (multiples, for example)
that predisposes you to pre-term labor, you may want to avoid the
nipple stimulation described in this article.  In this case,
check with your care provider.

On the other hand, if you are having a normal pregnancy
and have no known disposition to pre-term labor, there is
no reason not to use the methods described in this article.

Newsgroups: misc.kids.breastfeeding
Subject: Re: inverted nipples-success stories? (long)

Yet another inverted nipple sufferer posts asking advice and if anyone
has had success solving the problem.  I respond for three reasons.

1.  To say there ought to be a FAQ on this, it IS a frequently asked
    question.
2.  To say YES, Monika had severely inverted nipples before Clara was
    born.  We recognized the problem WHEN she got pregnant, and we
    solved it.
3.  To say that solving the problem is not rocket science.  Solving the
    problem is quite simple, but like all issues of reshaping the body,
    it takes time!  You can't go into it expecting to change overnight!

First, the human body is quite elastic (stretchable) and quite plastic
(reshapable) with the exception of bone, which is quite rigid.  This is
the first thing to note.

Inverted nipples are usually a result of the ligaments along the milk
ducts which run to the nipples (and the ducts themselves) as shorter
than the distance from from the center of the breast where they
originate to the nipple.  Hence they pull the end of the nipple in
toward the center of the breast, inverting it.  This is the second
thing to note.

Since the tissue is stretchable, if you can get hold of the end of
the nipple, you can pull it out to a protruding position.  The problem
is that as soon as you let go, it goes back to the inverted position.
However, each time it goes a little less far.  Pull it out 100 times
and it stays out a while, pull it out 1000 times and it may stay out
permanently.  Ths is the third thing to note.

These facts suggest a simple treatment.  Pull the nipple out and hold
it in a protruding position as LONG as is comfortable, then rest and
do it again as soon as it is recovered from the exertion.  Repeat over
a period of time.  And this is like both orthodontia and politics:
A small force over a long period of time accomplishes more than a
large force over a short period of time.

Now.  Some practical ways to accomplish this treatment...

A.  Get a hospital grade breast pump (ie: one with a strong pull) and pump
on the inverted nipples.  1.  You need to pump long enough to stretch
the nipple out and hold it in the stretched position long enough for
the internal ligaments to stretch somewhat.  I would suggest at least
15-20 minutes per nipple.  2.  I would suggest observing
to see if the pump is pulling the nipple out to a protruding position.
If not, you need to get a stronger pump or use another method.
3.  I would suggest starting no later than your 30th week.  This gives
you 10 weeks to uninvert the nipple.  4.  I would suggest at least 2
to 3 pumpings per day.  If you have more time, go for it.  5.  If you
have not made SIGNIFICANT progress by week 36, then increase both pumping
time and frequency or add another method.

B.  Get DH to provide the same suction.  Some people may find this
offensive, but I think it is more effective for two reasons.  1.  It
can be modified to suit the needs of the individual.  2.  It is more
like what the baby will do than any other method.

Here is the way I would suggest proceeding, if DH helps.  1.  Since
this is more effective DH can suck 10-15 minutes on each breast.
2.  DH should make sure to get the entire nipple and at least half
of the areole in his mouth and stretch out the nipple as far as
is comfortable, while massaging the deep tissue under the areole
with his tongue.  This encourages the ligaments and ducts to stretch
out more easily.  3.  Again, start by your 30th week.  4.  In this
case you can start with once every second or third day, and work
up to every day by 33 weeks and twice a day by 36 weeks, etc.
5.  I can't imagine not making progress by week 36 with this method.
But again, to increase progress, increase sucking time and frequency.

C.  Breast Shields.  This is the LEAST effective way to uninvert
nipples.  Why?  Because it does not apply ANY force to stretch the
nipple out to a protuding position, it simply presses the rest of
the breast mass back.  For that reason, if you choose to use this
method, I would suggest starting MUCH EARLIER than with the other two.

Both methods A and B can lead to sore nipples or tender breasts,
expecially if they are not used to contact.  In both cases I would
suggest applying Lansinoh cream and waiting until the soreness
subsides, at least from weeks 30 through 36.  Beyond week 36 you
have to trade off how much progress you have made in uninverting
the nipple versus how tender you are.  Another consideration is
that the baby will want to nurse 8 - 10 times a day.  If you can't
stand sucking or pumping three times a day, you may well have
pain problems feeding the baby.  Better to endure a little discomfort
early than a lot later on.

Monika and I used method B.  We actually started earlier than 30 wks
because Monika was quite anxious about being able to latch the baby
on if her nipples were inverted.  It took us about 10 weeks to "turn
them right side out."  Monika had the added benefit that she suffered
no nipple soreness when the baby came.  This was in contrast to the
5th or 6th week of turning her out when we had to rest a day because
of a tender spot or hairline crack.

Why do I feel so strongly about this?
  1.  I am a strong breastfeeding advocate, and I hate to hear of
      women who want to breastfeed but can't because
      a.  The baby can't latch onto the inverted nipple, or
      b.  The nipple is so painful the mother can't stand to feed.
      I know both of the conditions can be avoided.
  2.  Even though we had reversed Monika's inverted nipples, Clara
      had difficulty latching on at first.  This was quite stressful
      for both of us.  If the nipples were still inverted it would
      have made the problem worse, and we may be in group 1, above.

This works!  If you don't believe me ask Monika ( mmcmahan at home dot com).

As for the ones who have the problem, but only read this message just
before the due date (or even after the baby is born), my heart goes
out to you.  Depending on the severity of your inversion, you may have
to choose between enduring relatively more pain or not breastfeeding.
However, anything you do NOW to solve the problem will be gentler
than what the baby does.

If the baby is already here, I would suggest using the pumping method
immediately after a feeding.  If the baby is latching on at all, you
are probably getting all the sucking you need, and any addition may
well increase the soreness.  The pump can hold the nipple in place
with a little less force.

Good luck,
Larry



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