For Mary Broadfoot,

I share your concern about any new, untried but highly touted product such
as the Niplette.

You note that you were able to produce red marks on your chest using the
Niplette.  This colour change is due to disruption of the skin capilliaries,
medically termed petechiae and known in the vernacular as a hickey (spelling?)!

I believe you infer that anything that can damage normal skin can also
damage nipples.  I have always been amazed that the nipple manages to
survive breastfeeding as well as it does.  The infant's suck can produce a
vacuum of up to 200 mm of mercury as Dr. Mavis Gunther showed us this in
1945.  I doubt that the Niplette comes close to such levels.

Many among you who breastfed will also wince at rememberances of children
latching onto the breast skin instead of onto the nipple.  Again I make the
point that the nipple seems designed to tolerate high vacuums compared to
regular skin.

Finally, I would assume that the majority of women would note pain before
damage were to occur and  would either reduce the vacuum or remove the device.

This post is not meant to be a ringing endorsement of the device and I agree
with Mary's cautionary note, but we do have to admit that we are very poor
at getting mothers breastfeeding when they have significantly inverted or
retracting nipples.  I have not found that breast shells, Hoffman's
exercises or areolar massage are of significant effect and there is
virtually no literature on the subject to guide us.

Not to use in the last two months of pregnancy?  I would probably use common
sense.  If there is a history of premature labour or of significant
contractions I would probably not use it. Nevertheless, the stimulation is
tonic and I suspect response to the device extinguishes soon after its
application.  I would also put forward that male partners probably stimulate
things a whole lot more but they are not banished from the bed chamber if
all else is well!

In summary:  We have no good information on the hazards and advantages of
this product.  Still, we need a useful and safe product that brings truly
inverted and strongly retracting nipples forward in preparation for
breastfeeding.   Only clinical studies will be able to show whether or not
the Niplette is an effective and acceptable product.

Any patient that wishes to use it must be properly examined using a pinch
test and not just using visual inspection.  They must also be informed about
the lack of experience with this device and should be followed clinically.

Finally, I do not own shares in this product nor do I benefit from sales in
any way.

Phew.  Enough for now!

Shirley Gross
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M. Shirley Gross M.D.,C.M., C.C.F.P., I.B.C.L.C.
Director, Edmonton Breastfeeding Clinic
Edmonton, Alberta, Canada
E mail at  <  [log in to unmask]  >
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