Heather,

Is it possible that this is a type of adhesed nipple?  A portion of the
tip of the nipple is "glued" skin to skin from bodily secretions.  When
the newborn breastfeeds, the dimple is pulled apart leaving skin that is
raw and sore.  The dimpled area stays moist preventing healing.  This can
be quite painful for mother and she often complains of bleeding nipples.

This type of nipple is often mistakenly called an inverted nipple where
the whole nipple shaft inverts upon compression.  I frequently see dimpled
nipples accompanied by inverted nipples.  In our hospital the nurses
frequently bring mother breast shells for inverted nipples when they see
this dimple condition.  Of course, this does not begin to "fix" the dimple
problem.  As the perimeter of the breast shell opening rests around the
base of the nipple, the tip of the nipple remains adhesed or dimpled.

The primary treatment is to use a safe lubricant to massage and manipulate
the nipple out.  Then it is held open in the exposed position with a
special device,  the Dimple Ring.  They should be worn for about 10
minutes after each feeding to expose the inner dimple to air.  This needs
to be continued as long as soreness remains, possibly throughout the
breastfeeding experience.

Dimple Rings are available from the Lactation Institute in Encino, Ca.
818/995-1913 or www.lactationinstitute.org

I do see mothers whose nipple tip appears dimpled, however, it is very
minimally adhesed and is easily worked out.

(I am employed by the Lactation Institute as an LC and faculty member.  I
am also a hospital-based LC.)

Hope this helps,
Linda D. Kingsley

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