The three grades of nipple inversion and what each means for breastfeeding, four eversion techniques to try before feeds, when and how to use a nipple shield for latch support, which breastfeeding positions give you the most control, and how to build a practical toolkit that evolves as your baby's latch improves.
Inverted or flat nipples affect an estimated 10–20% of women. The nipple retracts inward rather than protruding outward — and for many mothers, this only becomes a concern when breastfeeding begins. The good news: most women with inverted nipples can breastfeed successfully. It often takes the right technique, the right tools, and professional guidance from a lactation consultant.
The key is understanding your specific grade of inversion, because the approach is different for each. A Grade 1 "flat" nipple may only need gentle stimulation before feeds, while a Grade 3 fully inverted nipple may require a nipple shield and specialized devices. The American Academy of Pediatrics recommends working with a certified lactation consultant (IBCLC) who can assess your anatomy and create an individualized plan.
The Three Grades of Nipple Inversion
The medical grading system — developed by Schwager and colleagues and widely used in clinical practice — classifies nipple inversion into three levels based on how easily the nipple can be drawn out and whether it stays protruded.
Grade 1 — Flat
Nipple sits level with the areola or is mildly inverted. Can be easily drawn out with gentle pressure and stays protruded for a sustained period. Minimal or no fibrosis. Milk ducts intact. Breastfeeding usually possible with positioning adjustments or brief pre-feed stimulation.
Grade 2 — Partial
Nipple can be drawn out but retracts back when released. Moderate fibrosis with retracted milk ducts. Breastfeeding is possible but baby may have difficulty latching. Typically benefits from eversion techniques before feeds and/or a nipple shield during feeds.
Grade 3 — Fully Inverted
Nipple cannot be drawn out manually. Significant fibrosis with constricted, severely retracted milk ducts. Breastfeeding is very challenging without assistance. Usually requires a nipple everter device, nipple shield, and close LC guidance. Expressing milk may be an alternative if direct latching isn't achievable.
Four Eversion Techniques
Eversion means drawing the nipple outward before latching. The goal is to present a more protruding surface that your baby can grasp. These techniques are most effective for Grade 1 and Grade 2; Grade 3 may need a dedicated everter device.
1. Pump suction (30–60 seconds). Apply your breast pump flange and run it briefly — just long enough to draw the nipple into the tunnel. This is the most commonly recommended technique by lactation consultants. Use the lowest effective suction setting. The NHS recommends this as a first-line approach for flat or mildly inverted nipples.
2. Nipple everter / suction device. Small suction cups (like the Niplette) apply gentle sustained negative pressure. Place over the nipple for 30–60 seconds before feeds. Most effective for Grade 1 and some Grade 2 inversions. Available without a prescription.
3. Hoffman technique. Place both thumbs on opposite sides of the nipple base. Press firmly into the breast tissue and stretch outward. This manual exercise aims to loosen the tissue that holds the nipple inward. Perform for about 1 minute per breast. Note: the Academy of Breastfeeding Medicine notes that evidence for this technique is limited, but many lactation consultants include it as part of a combined approach.
4. Cold stimulation. Brief contact with a cold, damp cloth can trigger the nipple to protrude reflexively. This is the simplest technique and can be combined with any of the above. Works best for Grade 1.
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View DetailsWhen a Nipple Shield Can Help
A nipple shield creates a firmer, more protruding surface that compensates for what the inverted nipple can't yet provide. For Grade 2 and Grade 3 inversions, a shield is often the bridge that makes direct breastfeeding possible while you work on the underlying latch.
Proper sizing matters — the shield should be fitted by your lactation consultant based on your nipple base diameter (typically 16mm, 20mm, or 24mm). An incorrectly sized shield causes more problems than it solves: too small compresses and restricts flow, too large slips and allows air swallowing. For a detailed step-by-step guide, see our nipple shield guide.
Shields are temporary. As your baby grows stronger and your nipple tissue responds to repeated feeding, many mothers wean off the shield within 4–6 weeks. The La Leche League International emphasizes that shields should always be used under professional guidance with regular follow-up to assess progress.
Best Breastfeeding Positions
| Position | Why It Helps | Best For |
|---|---|---|
| Football / Clutch Hold | Baby tucked under your arm. Your hand supports baby's head directly, giving maximum control over latch angle and depth. | All grades. Recommended starting position. |
| Cross-Cradle | Your opposite hand guides baby's head for precise positioning. Baby faces you tummy-to-tummy. | Grade 1–2. Good once basic latch is established. |
| Laid-Back / Biological | You recline and gravity helps baby find the nipple instinctively. Reduces pressure on you both. | Grade 1. Good for relaxed feeds once latch confidence builds. |
Latch sequence for inverted nipples: Tummy to tummy positioning first. Nose to nipple alignment. Wait for a wide-open mouth — don't rush this. Then guide baby chin-first, directing the nipple (or shield) toward the roof of baby's mouth. The Mayo Clinic provides illustrated latch guidance for new mothers.
Your Feed-Cycle Toolkit
| Phase | Tool | Purpose |
|---|---|---|
| Pre-feed (1–2 min before) | Pump suction, everter, or cold stimulation | Draw the nipple outward so baby can latch |
| During feed | Nipple shield (if needed for latch) | Provides a firmer surface baby can grasp |
| After feed | Silver nursing cups | Reduces friction from clothing, antimicrobial surface protection |
| Ongoing | LC follow-up | Track progress, adjust shield size, plan weaning |
Between Feeds: Silver Cups
Inverted nipples that are repeatedly everted for feeds — especially with pump suction — can become sensitive and irritated between sessions. Silver nursing cups sit over the nipple between feeds, providing a smooth dome that prevents clothing friction and offers an antimicrobial surface. They're not a latch tool (that's the shield's job during feeds) — they're a comfort tool for the hours in between.
This is particularly relevant for mothers working through Grade 2 and 3 inversions, where more aggressive eversion techniques (pump suction, everter devices) can leave the nipple area tender. The cups complement the rest of your toolkit without interfering with any of it. The Office on Women's Health provides additional guidance on managing nipple discomfort during breastfeeding.
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View DetailsWeek-by-Week Progress
Most families see meaningful improvement within the first few weeks. The timeline varies by grade, but a typical progression looks like this:
| Week | What to Expect |
|---|---|
| Week 1 | Full toolkit at every feed — eversion technique + shield + silver cups between feeds. Focus on establishing a consistent routine. |
| Week 2–3 | Begin reducing shield use during easier feeds where baby latches well. Continue eversion before every feed. |
| Week 4–6 | Many babies latch without a shield, especially for Grade 1–2. Continue silver cups for between-feed comfort as needed. |
| Week 6+ | Most Grade 1–2 parents are shield-free. Grade 3 may take longer. Continue LC follow-up to confirm milk transfer and weight gain. |
When to Seek Help
See your lactation consultant or healthcare provider if baby is consistently unable to latch despite eversion and shield use, if weight gain slows or diaper output drops, if you experience persistent nipple pain or damage that doesn't improve with technique adjustments, if you see signs of mastitis (red, hot areas on the breast, fever), or if you have a new onset nipple inversion after puberty (which should be evaluated to rule out other causes). The CDC and Stanford Newborn Nursery provide additional clinical resources for breastfeeding support.
📋 Editorial Note & Transparency
Medical Disclaimer: This content is educational and does not constitute medical advice. Inverted nipple management — especially for Grade 2 and 3 — should be guided by a certified lactation consultant (IBCLC) who can assess your specific anatomy and create an individualized plan.
Product Disclosure: Go Mommy manufactures the Silver Nursing Cups featured in this article. Go Mommy does not manufacture nipple shields, everter devices, or breast pumps. Information about these tools is based on published clinical guidelines.
Sources: AAP, ABM, CDC, LLLI, Mayo Clinic, NHS, Stanford, OWH.
Last reviewed: March 2026 · Content by Go Mommy editorial team
Frequently Asked Questions
Can I breastfeed with inverted nipples?
Yes — most women with inverted nipples can breastfeed successfully. Grade 1 and 2 inversions respond well to eversion techniques and nipple shields. Grade 3 is more challenging but not necessarily impossible with professional support. The baby latches onto the areola, not just the nipple.
How do I know my grade of inversion?
Do the pinch test: compress behind the nipple base with your thumb and forefinger. If the nipple protrudes and stays — Grade 1. Protrudes but retracts quickly — Grade 2. Won't come out at all — Grade 3. A lactation consultant can confirm and recommend the right approach.
What is the best eversion technique?
Pump suction for 30–60 seconds before feeding is the most commonly recommended approach. Combine it with cold stimulation or the Hoffman technique for Grade 2. Grade 3 may need a dedicated nipple everter device. Always latch baby immediately after eversion.
Do I need a nipple shield for inverted nipples?
Not always. Grade 1 often manages without one. Grade 2 frequently benefits from a shield, especially in the early weeks. Grade 3 typically needs a shield for most feeds. A shield should be fitted by an LC and treated as a temporary bridge, not a permanent solution.
Will my nipples stay inverted forever?
Not necessarily. Pregnancy hormones and the baby's repeated sucking can gradually draw inverted nipples outward. Many women find their nipples become less inverted over weeks of breastfeeding. Some stay permanently protruded after the breastfeeding period ends.
How do silver cups help with inverted nipples?
Silver cups are worn between feeds — not during. They create a smooth, antimicrobial barrier that prevents clothing friction on nipples that have been repeatedly everted and are tender. They complement the shield (used during feeds) and eversion tools (used before feeds).