Hi Lisa, Well, I'm going to stick the old neck out, gulp, and say something that I will probably get jumped all over for....but it sounds as though Mikayla might do really well with a nipple shield. I had a case that sounds virtually identical to yours a couple of years ago. Christopher just could NOT get on to the breast - same type of "playboy" tight taut breasts with inelastic skin & flat nipples. Unable to compress the areola at all or draw the tissue into his mouth. He happily nursed using the dreaded n.s. for 9 months, gained weight like a house afire. The mom pumped for the first few weeks to make sure her milk supply was adequate, but there was never any problem, and she even quit pumping. Christopher never did go to the breast alone though mom tried frequently. Her second baby she came to me during pregnancy, we started with br. shells and massage of br. tissue. She had a darling girl who latched on immediately after birth and never looked back! I'd suggest trying the nipple sucker/extender/adapted syringe first and see if you get anywhere using that. If not, you may want to opt for the n.s., especially if mom gets to the point of quitting. I'd go for that before prolonged fingerfeeding which is time consuming and the baby isn't at the breast...... Jan B.