Laurie writes:

<1. I can't tell you the number of moms who present for me to check and
suggest measures to improve their inverted nipples, who in fact have
normal
breast/nipples. Often the nipples are actually somewhat "short" or "flat"
but no intervention is needed, IMO. How many moms do you all really see
with
really pronounced EVERTED nipples? I truly see many many more short
flattish
ones. Is it because many moms are a tad or more overweight and many
breasts
very large and these seem to go with the "short" nipples? Just musing.
What
I am trying to say to Jane is, the mom really *may not* have inverted
nipples.>

I happened upon a valuable reference resource for me at the Lactation
Institute display booth at ILCA.
There was just one copy available at the conference, though it can be
purchased through the Lactation Institute. I was lucky enough to purchase
it and get the author's autograph.

It was "Human Nipples: Function and Anatomical Variations in Relationship
to Breastfeeding", the master's thesis of Yaffa Stark. I am particularly
glad to have the benefit of her excellent literature review.

It may contain one possible answer about the "overdiagnosis" of inverted
nipples, a term which I see too loosely used for meaningful communication
and guidance and very often, frightening mothers unnecessarily.

She composed a table to compare the different terminology to describe
nipple types, using four different sources. So one of the biggest
barriers to communication is that there is little agreement among HCP's
(or anyone else, for that matter)about the definition of "inverted".

I myself favor the use of the word "retracting" to describe the
functional response to areolar compression by the "pulling in" of a
nipple which may even appear everted or flat in its unstimulated state.

And I find it far more important to identify where the milk sinuses lie,
and show the mother where the baby's compression efforts need to be
applied.

Jean
*************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio





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