A recent post stated that the Nipplette applies controlled suction to the NON Pregnant, Non-Lactating nipple. Does this mean that there are no options for the woman who is already pregnant (not yet lactating and able to use the Evert-it?) Do women have to start this process before they even become pregnant? As a previously COMPLETELY flat nipple owner (except in the frozen food section) I found that judicious use of a breast shell for a minute or two pre-nursing in the first week was all that was needed. Good management in the first few days would prevent pathological engorgement ( I could have been the photo in the inside cover of BF and Human Lactation - yes go look at your copy now...- thanks to abyssmal hospital BF knowledge) and a bit of initial expression and baby do the rest. Second BF after next birth, nothing special was done other to to get BF going well from birth and skip pathological engorgement. This is different obviously from a truly inverted , not simply flat, nipple. Judy Fram, MEd., PT, LLLL, IBCLC Brooklyn, NY