Jennifer you wrote:
    What causes these indentations in the nipple  surface?
The nipple surface itself is concave, and difficult to heal probably  due to
folding on itself?  Is there a way to fix that?

I am jumping in here to comment on this but assuming that Jean will respond  
since she has written on this topic.
The indentations around the nipple at the point you saw this mom was  
probably due to her engorgement.  The same symptoms this mother may have  noted after 
delivery may have been due to edema from a combination of pregnancy,  and 
interventions in labor.  Not all women distribute edema alike.   There are some 
who are very prone to edema around the nipples and not that  noticeable in 
other parts of their body.  
Using the reverse pressure approach is very helpful to access the nipple  and 
allow the infant to get a deep latch.  I also encourage the moms to use  cold 
compresses as much as they can tolerate until the problem resolves.
Great job.
Ann Perry, RN IBCLC
Boston, MA

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