Cindy observes:

 
<The nipples themselves are not inverted, i.e. they do not go inwards, but
there is deep rim around the nipple that makes the nipple inset into the
breast, with stim, they come out, Its really hard to describe, has anyone
seen any like this? The nipple also has a cauliflower look to them. I looked
in the Breastfeeding Atlas and also dozens of pics on line and cant find one
that looks like hers.>

 
Cindy, 

 
IME the word "inverted" reminds me of the word "bellyache" as used in the 1930's in my childhood;-) I have for years been fascinated by nipple-areolar anatomy and function. The nipple attracts the most attention, but the "brains" (e.g. like the white rubber disc in some pumps;-) is in the subareolar function.
 
 
I am curious what you would find if, with mom's permission, you were to personally assess the subareolar function. Do very slow fingertip expression on an un-nursed or un-pumped breast, with your fingertips at least 2-3 cm or more back from the rim you decribe at the base of the nipple. Does the nipple begin to retract?? If so, this is what I call functional retraction.
 
 
Then test it again immediately after pumping, and observe for differences, and then, perhaps after a nursing as well.
 
 
My suspicion is that the ducts going through the nipple (galactophores) are being pulled backward by the insufficiently elastic subareolar ducts during the slight compression of the jaw and tongue, thus pulling the nipple backward out of the baby's grasp on latching and suckling. 
 
 
Microscopically, children, men, and adult women have what the histologist's terminology refers to as lactiferous sinuses. Those of adult women have more elastic tissue in conjunction with the walls.
 
 
Montagna W, Macpherson E, Some Neglected Aspects of the Anatomy of Human Breasts, Journ Inv Derm, July 1974, Vol 63;1: p. 10-16.

 
 
I wonder if it would help to free the subareolar tissues and ducts of any moveable tissue fluids and/or milk by using RPS (reverse pressure softening) with mother lying down on her back, for a full three minutes, and then reassess with fingertip expression. If you find what seems like less retraction, then having her do this before every latching might help lessen any damage. The ducts usually become more elastic with continued nursing, or pumping with an appropriately sized flange with the tunnel large enough to admit the area which you selected for effective fingertip expression.
 
Let us know if you try this and whether the results gave any clues as to what is going on. Or not. You will be doing basic reseach with your fingertips and your eyes, quite possibly the only evidence you can hope to get for the forseeable future;-)
 
Jean
 
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer
Dayton OH

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