Sarah,
Our midwives came to me with this question. I taught them  how to check for
inversion (most of them weren't sure about flat vrs inverted). Breast shells
are started at the first prenatal visit if inverted nipples are diagnosed.
The mother then sees us in the lactation clinic in the last month of her
pregnancy. We instruct her in hoffman's and nipple rolling to begin at the
end of the 36 th week along with strict instructions that if it causes
contractions to stop nipple stimulation.
My experience has been that because the nipple has been so burried for so
long that it becomes very sensitive (I use the example of the mom's navel
everting and becoming tender) even if prenatal preparation has been done. I
have also noticed that the  surface of the now everted nipple looks very
scaley and rough-- like there's a lot of dead skin or something over the
nipple. Has anyone else seen this? Is there a more clinical term than *horny
skin*? I feel funny charting that, for obvious reasons ;-)
Marie Davis