It has been my experience that the "nearly detached" nipple is a result
of tongue-tie...or submucous cleft, or any anatomic abnormality that
makes it difficult for the baby to "hang on" to the breast,
necessitating clenching with their gums and tugging on the shaft of the
nipple. (ouch)  These deep cracks will take weeks to heal, and the only
way for them to use a shell that keeps the crack held open between
feeds. (not hobbit-but usually the style intended for inverted nipples)
The wound needs to heal in from the bottom.  Otherwise, if the skin
edges are approximated between feeds, they try and start healing back
together, but every nursing or pumping they are again ripped apart.
(even AFTER the latch is fixed)  These are also colonized with bacteria
and yeast, so some bactroban(mupirocin) ointment helps.

Kathy Leeper, MD, IBCLC
Lincoln, NE

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