You just found out your nipples are flat or inverted. Now you're worried that pumping won't work for you.
Maybe your baby is struggling to latch. Maybe you're going back to work and need to pump. Either way, you're wondering if mothers with flat or inverted nipples can actually pump successfully.
Here's the answer: yes, you absolutely can. Between 10% and 20% of women have at least one flat or inverted nipple. Many pump effectively with the right approach.
The key is paying attention to flange sizing, using pre-pumping techniques, and adjusting your expectations during the first few weeks as your body adapts. This guide shows you exactly how.
Understanding Your Nipple Type
Before you can solve pumping challenges, you need to understand what you're working with. Flat and inverted nipples aren't the same thing. They respond differently to pump suction.
The Simple Pinch Test
Here's how to check at home. Place your thumb and forefinger about one inch behind your nipple, right at the edge of your areola. Gently squeeze inward. Watch what happens.
If your nipple sticks out or becomes more erect, you don't have a true inversion. If it stays flat against the areola, it's a flat nipple. If it pulls inward or dimples when squeezed, it's inverted.
Many nipples that look flat or inverted when you're just standing there will actually stick out when they're touched, cold, or stimulated. These respond really well to pumping.
The Three Grades of Inverted Nipples
Doctors classify inverted nipples into three grades. Knowing yours helps set realistic expectations.
Grade 1 (Sometimes called "shy nipples"): You can pull these out with your fingers, and they stay out for a while before slowly going back in. The tissue underneath has minimal scarring. Grade 1 inversions respond very well to pumping. Most mothers with Grade 1 can breastfeed directly and pump without major changes.
Grade 2 (Moderate inversion): You can pull the nipple out, but it goes back in quickly once you let go. There's some tissue scarring underneath. These nipples may need pre-pumping stimulation before each session at first. But regular pumping usually draws them out permanently within 2-6 weeks.
Grade 3 (Severe inversion): The nipple won't come out when you try to pull it. It stays deeply retracted. There's significant scarring and tissue shortening underneath. Pumping is still possible, but may need consistent pre-stimulation even after months. Some Grade 3 inversions never stay out permanently, but you can still pump successfully.
Why Flat Nipples Are Different
Flat nipples don't have the same tissue adhesions as inverted nipples. They simply don't stick out much. The good news? Flat nipples often respond even better to pumping than inverted ones because there's no bound tissue to stretch.
The challenge is just creating enough initial contact for the pump's suction to grab onto. Pre-pumping stimulation usually solves this. Many flat nipples become more prominent permanently after just a few weeks of regular pumping or nursing.
Why Pumping Actually Helps Your Nipples
If you're worried that pumping will be painful or ineffective, here's some reassuring news. Pumping doesn't just work around your nipple shape. It can actually improve it over time.
How Suction Gradually Draws Out Nipples
When a breast pump creates suction, it pulls your nipple and areola tissue into the flange tunnel. For inverted nipples, this repeated stretching helps break down the fibrous bands underneath that cause the inversion.
Think of it like stretching tight muscles. Consistent, gradual tension encourages the tissue to release and lengthen.
For flat nipples, the suction encourages the tissue to stick out more with each session. Over days and weeks, the nipple tissue "remembers" this extended position. It starts to stay out even between pumping sessions.
What Research Shows
A 2024 study compared electric breast pumps to the traditional inverted syringe technique. The results strongly favored electric pumps.
Both methods achieved similar breastfeeding success rates by Day 3 (around 56-60%). But mothers using electric pumps had significantly less pain. By Day 3, over 93% of electric pump users reported no or mild pain. Only 73% of syringe users could say the same.
The study concluded that electric pumps should be preferred for their comfort and effectiveness. The rhythmic suction pattern mimics a baby's natural sucking, which may explain why it works better.
Other research shows that trying to "fix" your nipples during pregnancy doesn't help much. Don't stress about exercises or devices before birth. Focus on effective techniques after delivery when your body is actually making milk.
Choosing the Right Breast Pump
Not all pumps work equally well for flat or inverted nipples. Your pump choice can make a big difference in your comfort and success.
Electric vs. Manual Pumps
Electric pumps are generally better for flat and inverted nipples. They provide consistent, controlled suction that you can gradually adjust. The rhythmic pattern helps stimulate milk flow even when your nipple isn't fully out initially.
Double electric pumps are even better. They let you pump both breasts at once, saving time and often increasing output.
Manual pumps can work for flat nipples and Grade 1 inversions, especially if you're only pumping occasionally. But manual pumps require more effort. Hand fatigue can lead to shorter, less effective sessions.
If you're planning to pump regularly or exclusively, invest in a quality electric pump.
Hospital-Grade Pumps
Hospital-grade pumps offer stronger suction and more precise control than regular pumps. For Grade 2 and Grade 3 inverted nipples, this extra strength can make the difference between success and frustration.
These pumps are available for rent from lactation consultants, hospitals, and medical supply companies. They typically cost $50-75 per month.
Consider renting one for the first 4-6 weeks if you have severely inverted nipples or if a standard electric pump isn't working. Once your nipples are drawn out and your supply is established, you can often switch to a regular pump.
What About Wearable Pumps?
Wearable pumps are convenient for hands-free pumping. But they're not ideal for initial pumping when you're trying to draw out flat or inverted nipples. The suction is typically less powerful than traditional electric pumps. Plus, you can't see your nipple response during pumping.
Once your nipples are out and you've established your supply, wearable pumps can be excellent for maintenance sessions. They're particularly useful if you only have flat nipples (not inverted), as these often respond well to moderate suction once you've got a routine going.
Getting the Flange Fit Right
This is critical. For mothers with flat or inverted nipples, flange sizing can be the difference between painful, ineffective pumping and comfortable, productive sessions.
Many pumping problems blamed on nipple shape are actually flange fit issues.
How to Measure When Your Nipple Is Flat
Measuring a flat or inverted nipple takes more work than measuring one that sticks out. Here's the best approach.
Step 1: Stimulate your nipple first. Use a cold compress, gently roll it between your fingers, or pump at low suction for 30-60 seconds. Get your nipple as everted as possible.
Step 2: Measure the base of your nipple (where it meets the areola) at its widest point when it's out. Use a soft measuring tape or download a nipple ruler template online. Measure in millimeters.
Step 3: If your nipple won't come out enough to measure clearly, estimate conservatively. It's better to start slightly large and size down than to start too small and cause damage.
Important: Measure both sides. Your nipples can be different sizes. You may need different flange sizes for each breast.
The Sizing Rule
Once you have your nipple measurement, add 0-3 millimeters to find your ideal flange size.
For inverted nipples, start by adding 2mm. For flat nipples, add 1-2mm. This small buffer allows your nipple room to expand during pumping without your areola being pulled into the tunnel.
For example, if your everted nipple measures 17mm at the base, try a 19mm or 20mm flange first.
Most pumps come with standard 24mm flanges, which are often too large for women with flat or inverted nipples. You'll likely need to purchase additional sizes separately.
Signs Your Flange Fit Is Right or Wrong
Too small: Painful chafing or friction on the sides of your nipple. Your nipple touches the end of the tunnel. Blisters, swelling, or peeling skin.
Too large: Your areola gets pulled into the tunnel along with your nipple. Swelling around where the flange meets your breast. Your nipple moves around too much.
Just right: Your nipple moves freely without touching the sides or end. Only your nipple (not areola) enters the tunnel. Pumping feels like a gentle pull, not painful suction. Your breasts feel soft and empty after pumping.
Dealing with Elastic Nipples
Some mothers discover they have elastic nipples when they start pumping. Their nipples stretch much farther into the tunnel than expected, sometimes reaching the end even with correct sizing. This is more common with flat nipples.
If this happens: Try a smaller flange size. Turn down the suction strength. Don't lubricate your flanges. Consider silicone inserts that sit inside your flanges. Consult an IBCLC for professional fitting guidance.
Pre-Pumping Techniques That Work
For many mothers with flat or inverted nipples, success comes down to what you do in the 2-3 minutes before you start the pump. These techniques help bring your nipple out so the flange can create a proper seal.
The Cold Compress Trick
Cold temperature makes nipples contract and stick out. It's simple physics, and it works remarkably well.
Keep a chilled spoon in the refrigerator. Use a clean ice cube. Or apply a cold gel pack to your nipple for 15-30 seconds right before pumping. You should see your nipple become more erect within seconds.
Some mothers keep disposable nursing pads in the freezer and apply them dampened. Just be gentle. You want cold enough to stimulate, not so cold it's uncomfortable.
Nipple Rolling
Gently roll your nipple between your thumb and forefinger for 30-60 seconds. Use firm but comfortable pressure, like rolling dough between your hands. Roll in different directions—up and down, side to side, circular motions.
You can also try this: Place your thumb and fingers on opposite sides of your areola about one inch behind the nipple. Press gently inward (toward your chest) and slightly back while pushing forward on the areola. This helps push the nipple outward. Hold for 5-10 seconds, release, and repeat 3-4 times.
Reverse Pressure Softening
If engorgement is making your normally flat or inverted nipples even flatter (common in the first week after birth), this can help.
Place your fingertips in a ring around the base of your nipple. Apply gentle, steady pressure inward (toward your chest) for 45-60 seconds. This temporarily moves fluid away from the areola, allowing your nipple to stick out more.
Do this before other nipple techniques if you're engorged. An engorged breast makes it nearly impossible to pump effectively, regardless of nipple shape.
Using a Nipple Everter
Nipple everters are small, handheld suction devices designed to draw out flat or inverted nipples before nursing or pumping. They're like tiny breast pumps but simpler and cheaper.
You place it over your nipple, squeeze the bulb to create gentle suction, hold for 30-60 seconds, and release. Your nipple should stick out for several minutes afterward.
Your First Pumping Session: Step by Step
Your first few sessions set the foundation. Here's exactly what to do.
What to Have Ready
- Your breast pump, fully charged or plugged in
- Correctly sized flanges (have 1-2 sizes on hand to test)
- Clean bottles or containers attached
- Cold compress, chilled spoon, or ice cube
- Comfortable pillow for back support
- Water bottle—pumping is thirsty work
- Warm cloth or heating pad for breasts
- Nipple cream for afterward if needed
- Clean cloth to dry nipples after pumping
- Phone or something to keep you occupied
The Pumping Process
1. Stimulate your nipples. Use cold compress, nipple rolling, or reverse pressure softening (if engorged) for 1-2 minutes per breast. Get your nipples as everted as possible.
2. Warm your breasts. Apply a warm (not hot) cloth or heating pad for 2-3 minutes. This encourages blood flow and can trigger letdown. Skip this if you have a strong letdown naturally.
3. Position the flanges. Center your nipple in the tunnel. The flange should lay flat against your breast with no gaps.
4. Start with low suction. Turn your pump to the lowest setting. For inverted nipples especially, starting too strong can be painful and make your nipple retract.
5. Wait for letdown. Keep the pump on low for 2-3 minutes. You should feel a tingling or see milk starting to spray when letdown happens.
6. Gradually increase suction. Once letdown occurs, increase the suction to a comfortable level. "Comfortable" means you feel a strong pull but no pain.
7. Pump for 15-20 minutes total. Continue until milk flow slows to drops, usually around 15-20 minutes.
8. Massage during pumping. Use your free hand to massage in a circular motion from the outer breast toward the nipple. This can increase output significantly.
Start Low, Build Gradually
Many mothers with inverted nipples make the mistake of starting with high suction, thinking it will pull their nipples out faster. This usually backfires. It causes pain and makes nipples retract defensively.
Think of suction strength like weight training. You start light and build up gradually as your tissue adapts.
Start at the lowest setting for your first session. In later sessions, increase by one level if the previous one was comfortable. You should reach your optimal level within 3-5 days. That's usually about 60-70% of maximum for most mothers.
Equipment That Can Help
Beyond your pump and flanges, several accessories can make pumping easier.
Nipple Shields
Nipple shields are thin silicone covers that fit over your nipple during nursing. They're mainly for helping babies latch, not for pumping.
If you're trying to nurse with a shield and then pump afterward, you can leave it on while pumping if removing it makes your nipple retract immediately.
Don't rely on shields as your main pumping solution. They can reduce milk transfer and should only be used with an IBCLC's guidance.
Breast Shells
Breast shells are hard plastic domes with a hole in the center. You wear them inside your bra between feedings or pumping sessions. They protect sore nipples from rubbing against fabric and can help keep inverted nipples out after pumping.
Use these only if your IBCLC recommends them. They're not necessary for most mothers and can sometimes create problems like blocked ducts if worn too long.
Hands-Free Pumping Bra
A hands-free bra holds your flanges in place so you don't have to. This frees your hands for breast massage, adjusting pump settings, or just scrolling your phone.
For mothers with flat or inverted nipples, this is especially valuable because you can massage your breasts during pumping to improve milk removal.
You don't need an expensive one. Many mothers cut small slits in an old sports bra. Purpose-made pumping bras typically cost $20-40.
Managing Pain and Discomfort
Some discomfort in the first days to weeks is normal when pumping with inverted nipples. Knowing what's normal versus what's a problem helps you power through temporary soreness without ignoring genuine issues.
Why Soreness Happens
Inverted nipples are caused by fibrous bands underneath that bind the skin to deeper tissue. When pumping stretches these adhesions, you may feel soreness like sore muscles after exercise.
This is a sign the tissue is gradually lengthening, which is good even though it's uncomfortable.
For flat nipples, soreness usually comes from tissue that's not used to being stretched. Your nipple needs time to adapt.
This normal soreness should peak in the first few days and steadily improve. By Day 3, most mothers notice significant pain reduction. By two weeks, soreness should be minimal.
If soreness continues past two weeks or gets worse, something is wrong—likely flange fit or suction settings.
Drying Inverted Nipples After Pumping
Here's a problem unique to inverted nipples. After pumping or nursing, your nipple may go back inward while still wet with milk. This creates a warm, moist pocket where bacteria and yeast can grow.
Prevent this by patting your nipples completely dry with a clean cloth immediately after pumping, before they retract. Some mothers use a hair dryer on a cool or warm (not hot) setting.
If your nipples retract quickly despite drying efforts, breast shells worn for 15-20 minutes after pumping can keep them out until they're fully dry.
Nipple Care Between Sessions
Keep your nipples moisturized and protected between pumping. Medical-grade lanolin is safe for breastfeeding and doesn't need to be washed off. Some mothers prefer coconut oil. Apply after pumping once your nipples are completely dry.
If you develop cracks, hydrogel pads worn between sessions can speed healing dramatically.
Exclusive Pumping: When Direct Nursing Isn't Working
If you've tried everything and direct nursing still isn't working because of your nipple shape, exclusive pumping is a completely valid choice. Many mothers successfully feed their babies exclusively with pumped milk for months or even a full year.
Can You Maintain Supply?
Yes. Research is clear that frequent, complete breast emptying maintains milk supply, whether from nursing or pumping. The key is frequency and thoroughness, not the method.
Many exclusive pumpers make more milk than their babies need and can even donate to milk banks.
That said, pumping is work in a way that direct nursing isn't. You need to pump frequently (at least 8 times daily initially), clean equipment, store milk, and then feed your baby separately.
But if your nipple shape makes nursing extremely painful or impossible, exclusive pumping is far better than struggling through painful nursing.
Recommended Schedule
To establish and maintain a full supply through exclusive pumping, follow this schedule for at least the first 4-6 weeks:
Weeks 1-2: Pump every 2-3 hours during the day and at least once at night. Total of 8-10 sessions in 24 hours. Yes, this includes overnight. Nighttime prolactin levels are highest.
Weeks 3-6: Continue 8 sessions in 24 hours. You can stretch the overnight interval to 4-5 hours if your supply is established.
After 6 weeks: Some mothers can gradually drop to 6-7 sessions daily while maintaining supply. This varies greatly. Don't reduce until you're confident your supply is stable.
Each session should last 15-20 minutes, or until your breasts feel soft. Pump both breasts simultaneously if possible.
Pumping from One Breast Only
Here's great news: you can make enough milk from one breast to fully feed your baby. Breasts operate independently. Whichever breast is used more will produce more milk.
If only one of your nipples is severely inverted, nurse or pump exclusively from the less affected side. Your body will respond by producing enough milk for complete nutrition.
The affected breast may become smaller due to reduced stimulation. This is purely cosmetic and will equalize after weaning.
Troubleshooting Common Problems
Even with correct technique, you may encounter challenges. Here's how to solve the most common ones.
Low Milk Output
Check your timing. Are you pumping frequently enough? If you're only pumping 5-6 times daily in the early weeks, your supply may not establish fully. Increase to 8 sessions for one week.
Check hydration and nutrition. Dehydration and undereating directly reduce supply. Aim for 100+ ounces of water daily.
Try hands-on pumping. Massage and compress your breasts during pumping. This can increase output by 48%.
Nipple Keeps Retracting During Pumping
If your nipple comes out initially but goes back in mid-session:
Hold gentle outward pressure. Use your free hand to hold your breast skin gently pulled back while pumping.
Increase suction slightly. Your suction may be too gentle to maintain eversion.
Apply cold mid-session. Pause pumping, apply your cold compress for 15-20 seconds, then resume.
Areola Pulling Into the Tunnel
If you see your areola being pulled in along with your nipple:
Reduce suction. High suction pulls more tissue in. Lower by 2-3 levels.
Try a smaller flange. Even if it seems wrong, a smaller flange often solves this.
Don't lubricate. Oils or creams make the areola pulling dramatically worse.
Painful Chafing or Blisters
Friction damage means your flange is rubbing your nipple. This happens when the flange is too small or when your nipple swells and touches the sides.
Stop until healed. Give your nipple 24-48 hours to heal. Hand express if needed.
Reassess flange size. You may need to go up one size now that your nipple sticks out more.
Apply healing care. Medical-grade lanolin and hydrogel pads speed healing dramatically.
When to See a Lactation Consultant
Professional help can save you weeks of frustration. Don't wait until you're completely discouraged.
Red Flags That Need Professional Help
Contact an IBCLC (International Board Certified Lactation Consultant) if:
- You have significant pain that doesn't improve after one week
- You see no improvement in nipple eversion after two weeks
- Your milk supply seems low (less than 12-16 ounces total in 24 hours by Week 2)
- Your baby isn't gaining weight appropriately
- You've tried multiple flange sizes, but none feel comfortable
- You have nipple damage that's not healing
- Your mental health is suffering from pumping stress
How an IBCLC Helps
IBCLCs are trained to assess nipple anatomy in ways that go beyond what you can evaluate yourself. A consultant can watch you pump, observe your nipple movement in the flange, and immediately identify issues you might not notice.
They can measure your nipples accurately when everted, recommend specific flange sizes, suggest alternative strategies, and help you decide whether exclusive pumping or direct nursing is best for your situation.
Insurance Coverage
In many countries, including the United States, insurance plans must cover lactation consultant visits. Many cover 6-8 visits per pregnancy.
Even if your insurance doesn't cover it, many consultants offer sliding scale fees. The cost of 1-2 visits (typically $100-300) is far less than the cost of premature weaning and formula if that's not your choice.
Frequently Asked Questions
Can I exclusively pump if I have inverted nipples?
Yes, absolutely. Many mothers with inverted nipples successfully maintain full milk supply through exclusive pumping. Research shows that pumping 8 or more times in 24 hours provides adequate stimulation. If direct nursing proves too difficult, exclusive pumping is a completely valid choice. Your baby will receive all the benefits of breast milk. Some mothers pump exclusively temporarily until their nipples are drawn out, while others continue for months.
What flange size should I use if my nipples are flat?
Measure your nipple at the base (widest part where it meets the areola) when it's as everted as possible after stimulation. Add 0-3 millimeters to find your ideal size. For flat nipples, start by adding 2mm. During pumping, watch to ensure your nipple moves freely without your areola being pulled in. Most pumps come with 24mm flanges, but many women with flat or inverted nipples need smaller sizes (17-21mm). You may need to purchase additional sizes separately.
Does pumping hurt more when you have inverted nipples?
You may experience more soreness during the first two weeks as the pump draws out your nipples and stretches tissue underneath. This is normal and typically improves significantly by Day 3. Most discomfort resolves within two weeks. However, sharp pain, bleeding, cracks, or blisters are not normal and usually mean incorrect flange sizing or too-high suction. A 2024 study found that mothers using electric breast pumps experienced significantly less pain than with manual methods. If pain persists past two weeks, something needs adjustment.
How long does it take for pumping to permanently change inverted nipples?
The timeline varies based on the grade of inversion. Grade 1 inversions often respond within days to weeks. Grade 2 inversions typically take 2-6 weeks of regular pumping before nipples stay out between sessions. Grade 3 inversions may require months of consistent pumping, and some may not achieve permanent eversion but can still pump successfully. Many mothers report that by the time they wean their first baby, their previously flat or inverted nipples stay out permanently, making nursing their second child much easier.
Should I use a nipple shield when pumping with flat nipples?
Nipple shields are primarily designed for direct nursing, not pumping. Instead, try pre-pumping techniques like cold compress stimulation, nipple rolling, or reverse pressure softening to draw out your nipple before placing the flange. If you're pumping after attempted nursing with a shield already on, you can pump with it in place, though it may slightly reduce output. Generally, focus on flange fit and pre-pumping stimulation rather than adding shields to your pumping routine.
Will my inverted nipples go back in after I stop pumping?
Many mothers find that once their nipples have been drawn out through consistent pumping or nursing, they stay everted permanently even after weaning. The repeated stretching gradually releases the fibrous tissue bands that caused the inversion. However, this varies by individual and by the grade of inversion. Grade 1 inversions are most likely to become permanently everted. Grade 3 inversions may retract again after weaning, but subsequent children often find it easier to breastfeed because the tissue has already been stretched once.
Final Thoughts: You Can Do This
Pumping with flat or inverted nipples requires patience and the right approach. But thousands of mothers do it successfully.
Focus on the fundamentals: correct flange sizing, pre-pumping stimulation, starting with low suction, and giving your body time to adapt. Most mothers see significant improvement within 2-4 weeks.
If you're struggling, reach out to an IBCLC. Professional guidance can make the difference between frustration and success.
Your dedication to providing milk for your baby is remarkable. Don't let nipple shape stop you from feeding your baby the way you want to. With the right techniques and support, you can absolutely pump successfully.
Need a pump designed for comfort and adjustability? SilkMum's Premium Wearable Breast Pump offers customizable suction settings and is compatible with multiple flange sizes to help you find the perfect fit. Explore our wearable pump.
References
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- Medela. Breastfeeding with flat, inverted or pierced nipples. Updated July 2025.
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- Kaya Ö, Tecik S, Suzan ÖK, et al. The effect of interventions on flat and inverted nipples on breastfeeding. J Pediatr Nurs. 2023.
- Boober. Tips for breastfeeding with inverted or flat nipples. Updated November 2024.