What are elastic nipples, and how do I know if I have them?

It is surprising how common elastic nipples are, and also how relatively unknown the condition is in the UK!  Very simply put, elastic nipples are where breast tissue stretches too much when pumping, either in the form of your nipple puffing up to twice it's size, or where nipples stretch so far that they touch the end of the flange tunnel, pulling areola tissue with them.

Most of the time, elastic nipple tissue is nothing to worry about. In fact, during feeding, your nipple and areola are designed to flex and stretch to comfortably fit the contours of baby’s mouth. Combined with a deep latch so that the nipple rests at the junction between baby’s hard and soft palate, this prevents nipple damage, optimises milk transfer and promotes a healthy milk supply.

You are most likely to notice elastic nipples when expressing to give your baby supplemental feeds, to increase milk supply or if separated from your baby.

During pumping nipples are usually drawn around halfway down into the shell, with the nipples free to move and increase in size with the vacuum of the pump, but without enough space around the nipples to also draw in the areola. If your nipple and areola stretch too far the nipple can swell and extend deep into the flange and reach the end causing painful swelling. You may find that your nipples rub along the inside of the breast shell causing pain or damage to the shaft of your nipple due to friction. If your areola is drawn deep into the flange too, this can lead to compression of the areola and milk ducts. You may notice that you have a much slower flow during pumping and low output despite your breasts feeling full.  If this continues, it can lead to engorgement, blocked ducts, mastitis and eventually low milk supply as a result of poor drainage.

What can help with elastic nipples?

There are several things that can help to reduce the impact of elastic nipples.

1. Check Your Flange Fit

Firstly, it is worth checking the fit of the flange. It is often recommended that if your nipple swells a lot during pumping to try going up a shell size. This may work for some people; however others find this leads to too much areola being drawn into the shell.  A good starting point when reviewing your shell size is to measure the diameter of the base of your nipple in mm and check your shell size is appropriate.

Below is an approximate guide:

This is important, because a flange that is much too wide is more likely to suck your areola deeper into the breast shell than one that fits well.

If you find that you still have a lot of breast tissue drawn into the shell then it is worth trying a size down or looking into silicone shells and inserts.

Once you have the right breast shell size, it is then worth looking at your pumping technique. Applying a suitable lubricant such as nipple balm or coconut oil (less is more!) may help an elastic nipple to glide more smoothly inside the breast shell without friction, meaning you can use a smaller shell with less chance of your areola being drawn into the tunnel and compressed, also reducing friction and associated nipple trauma.  

2. Adjust the Suction on your Pump

The next thing to consider is adjusting the suction on your pump. Many pump manufacturers recommend starting on a stimulation setting (rapid frequency, low vacuum) and then once milk starts following switching to collection mode (low frequency, high vacuum). This does not always work well for those with elastic nipples as the long deep suction can draw more breast tissue into the shell, compressing milk ducts and reducing milk flow.

If you find that these adjustments do not help, it is time to consider introducing silicone inserts which reduce the width of your breast shell and at the same time cushion your breast, increasing stimulation and preventing your areola being drawn into the shell.

3. Beaugen Cushions

Some inserts such as the BeauGen Breast Pump Cushions fit inside your shell, gently cupping your breast tissue and holding it back, preventing your areola from entering the tunnel of your shell and at the same time gently stimulating your nipples and areola.  Imported from the USA, BeauGen Breast Pump Cushions reduce pain and discomfort, create a customised fit (because they lower the size of your hard flanges by 2mm), and enhance your pumping experience by creating a soft pillowy cushion between your nipples and the hard plastic of your flanges.

You can also fold the shaft of the cushion if you need to reduce the size of your flange by 4mm!

Where mums with elastic nipples benefit greatly from BeauGen Cushions, mums with normal breast tissue do as well, because the cushion softens the hard plastic of normal flanges.

4. LacTeck BabyMotion Flange

An alternative to using silicone inserts with your breast shells it to consider swapping out your plastic breast shells with silicone flanges.

The LacTeck BabyMotion Flange is a silicone flange which is designed to be used in place of a plastic flange instead of fitting inside your breast shell like an insert. It has an internal silicone valve which flexes to compress and release the areola during pumping which is especially helpful for those with very elastic nipples and areolas which are often otherwise compressed throughout the pumping session.

These soft flanges come in sizes 15mm to 27mm.

5. Pumpin' Pals Silicone Flange

An alternative to the above is the Pumpin’ Pals Silicone Flange range. This range of flanges not only reduces over stretching by supporting your breast tissue, they can also be used at different angles meaning they suit a much wider range of different breast structures, elastic or not! Pumpin’ Pals flanges are tapered - the graduated width of the funnel prevents too much tissue bring drawn into the flange, reducing compression and helping milk to flow. In addition to this, the end of the flange and the connector fit together more smoothly- so even very elastic nipples can avoid trauma caused by the hard ring found at the base of plastic breast shells.

The Pumpin' Pal X-Large, Large & Medium sizes are hard silicone, but the Small and X-Small Pumpin' Pals  are soft silicone flanges with Elast+Assist Technology™ (EAT), which actively holds back breast tissue, preventing it from stretching too far.

It can take some trial and error finding what works for you and this process may feel frustrating. Remember, as with most pumping and feeding challenges, there is always a workable solution to help you to give as much of your milk to your baby, as efficiently as possible.

If you have any questions, or even any comments about your experience of Elastic Nipples, please feel free to comment below.  We'd love to hear from you.