After two and a half years of working at a hospital as an LC and seeing brand-
new babies I've concluded that I agree with those who do not comment on flat
nipples to the mom before the baby's birth.  I have seen that what matters
more is how well the baby can take the breast into the mouth.  And how the
breast is shaped.  The rounder, less compressible breast with flat nipples is
harder than  the conical breast.

Some babies have no trouble at all.  Sometimes in the beginning the mother
needs help shaping her breast ( not stimulating or forming the nipple) so that
the baby can get his/her mouth around enough areola.  Sometimes the mother
instinctively goes to the side of her breast besides the areola and pinches a
bit of breast which results in narrowing the amount of breast the baby has to
grasp.

The more experienced nurses at our hospital seem to have more success than the
newer ones in aiding latch with flat nipples.  They all form the breast for
the mother and baby.  I do use Chole Fisher's concept of having the baby's
lower lip further from the base of the nipple than the upper.

Occasionally one of the HCPs who attend births sends a mother to me for a
prepartum consult because her nipples are flat.  I just tell her that breasts
and nipples come in all sorts of varieties.  That the baby breastfeeds, not
nipple feeds.  That often a baby has a large enough mouth and/or gape that
enough breast will be taken in.  That the best thing to do is wait and see how
well the baby can do and assist when necessary in shaping the breast for the
latch.

I, too, have seen a mother with no discernible nipple.  Her breast just curved
at the end and did have nipple pores but no distinguishable difference in skin
or erectility.  Her baby was born at home and had not yet latched.  She had
him on a diaper changing table and was leaning over him with no bra on and he
opened his mouth and latched!!  She continued to feed him on the table every
time after that until he was able to feed in her arms a few days later!

Mardrey Swenson