Lactation Institute training uses differing terminology for various
*types* of nipple inversions. Pictures do a lot to show the variations.

From past cases, I remember one mother that I could have helped more
*humanely* had I finished the LI training before I'd met her. Her
nipples were so inverted that the midwife sent her to see if I thought
there were nipples, and yes they were present. The nipples were so far
into the breast that the tissue had two separate foldings.
Unfortunately, breast shells did not place any pressure at the base of
the nipple, it was, she was unable to roll the nipple between her
fingers (as suggested by others - bc it was too deep into the breast
tissue).

If I ever see another case like this I will suggest the LI routine of
gently, with fingers only working down into the breast tissue with a
lubricant (olive oil) to help ease the tissue apart. The secretions from
the breast have had a long time to exert their adhesive properties on
that folded tissue. Bringing the tissue forward abruptly, pumping or
even using a syringe (mom of course being the one to do this) may allow
the thin tissue to give way - before the secretions breakdown and the
result is torn tissue and the possibility of bleeding. That's what
happened with this mom, even though she waws careful with the pumping
first to bring out the nipple and never did want to use a syringe. It
was too much suction and too little give of those darned dried
secretions way inside the folded (literally) tissue. I can picture her
nipples still. (and i've already been chided for not asking and shooting
pictures).

Interestingly, this mom also had multiple nipples, over and under each
breast.

She actually pumped for mamy months despite the initial tearing (and
pain) for her beautiful baby.

Paula Bermingham, IBCLC
WIC BF coordinator
Lake County CA