Inverted nipple
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An inverted nipple is a nipple that, instead of pointing outward, is retracted into the breast and sometimes cannot be seen. In some cases, the nipple will be temporarily uninverted if stimulated, but in others, the inversion is permanent. It can occur in both women and men, and some people have one nipple that is inverted and one that is not.
In women, one way to protract inverted nipples is breastfeeding. An infant that latches on well can draw out an inverted nipple. Cosmetic surgery can also change the nipple's appearance, but such surgery often entails severing the milk duct and eliminating the ability to breastfeed. While inverted nipples may make breastfeeding more difficult, truly inverted nipples are rare and many women with inverted nipples can breastfeed without a problem. The baby sucks on the areola, not the nipple so there should be no problems.
There are several levels of nipple inversion; minor, moderate and severe, which would describe a nipple that retracts greatly to alongside or even below the areola.
Many women use a nipple treatment to help draw the nipple out for breastfeeding. Most experts do not recommend treatment during pregnancy given that pregnancy hormones may help the nipples to protrude before the baby is born.
There are a few treatments for inverted nipples. The first one is making sure that there is a good latch between the breast and the baby. Another measure is to shape the nipple. This is known as a “breast sandwich" or “nipple sandwich”, commonly used to get more breast tissue into a baby’s mouth. The use of a breast pump or other suction device immediately before a feeding may help to draw out inverted nipples. A high-quality, hospital grade, electric pump may be used for this purpose. There are special devices specifically designed to draw out inverted nipples before feeding or a home made nipple protractor can be constructed out of a 10 cc disposable syringe. Breast shells may be used to apply gentle constant pressure to the areola in order to try and break any adhesions under the skin that are preventing the nipple from being drawn out. The shells are worn inside the bra. The Hoffman technique is a nipple stretching exercise that may help loosen the adhesions at the base of the nipple when performed several times a day. However, while both these techniques are heavily promoted, a 1992 study by Alexander, Grant & Campbell found that not only do shells and the Hoffman technique not promote more successful breastfeeding, they may actually disrupt it.<ref>Alexander JM, Grant AM, Campbell MJ., Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-proctractile nipples, British Medical Journal. 1992 Apr 18;304 (6833):1030-2.</ref>
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