Dewew KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112:607–19. Vazirinejad R, Darakhshan S, Esmaeili A, Hadadian S. The effect of maternal breast variations on neonatal weight gain in the first seven days of life. Int Breastfeed J. 2009;4:13. I also had the Lansinoh LatchAssist Nipple Everter to bring to the hospital to use right before feedings and this helped right away. But soon, due to the constant nursing, I didn't really need it anymore. While standing in front of a mirror, hold the areola on each breast between your thumb and forefinger.

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerlć K, et al. SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7. The World Health Organization. The World Health Organization’s infant feeding recommendation. Available from: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/. Last accessed 17 Dec 2018. Wear your Niplette under your clothing. If you're wearing a tight top, you can conceal the Niplette with a specially designed protective cover. La correzione permanente si ottiene, in genere, dopo l'applicazione continua per un periodo di tempo variabile da 30 a 90 giorni. Come regola Niplette deve essere applicata per almeno 8 ore giornaliere senza interruzione, anche se alcune donne preferiscono applicare Niplette nelle ore notturne. Alexander JM, Grant AM, Campbell MJ. Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples. BMJ. 1992;304(6833):1030–2.On the first day postpartum, the following information will be collected: exclusive breastfeeding (yes/no), use of artificial milk (number of feeds in 24 h, justification), sore nipple (yes/no), pain while breastfeeding (yes/no), compliance with the use of the syringe technique before each breastfeed (experimental group only), and the use of other conservative methods to pull out the nipple (in both groups). Chakrabarti K, Basu S. Management of flat or inverted nipples with simple rubber bands. Breastfeed Med. 2011;6(4):215–9. Put the suction cup on the nipples, long press the power button to start the machine, short press the power button to select modes, press "+" or "-" to adjust gears, and then start to correct. Eligible pregnant women will be recruited from the Women’s Health Center and the Delivery Suite of the American University of Beirut Medical Center, Beirut, Lebanon. An inverted nipple is defined as a condition in which the nipple is pulled inward into the breast instead of pointing outward, classified according to Han and Hong [ 12]. During regular working hours, a trained research assistant will recruit eligible women after explaining the trial’s objective and procedures and verifying inclusion criteria. Written informed consent will be obtained from all participants. Randomization On months 3 and 6 postpartum, we will call the participants to collect information on infant feeding methods, adverse events, and infants’ weight at 3 and 6 months. Data management and quality assurance

Bouchet-Horwitz, J. (2011). The use of supple cups for flat, retracting, and inverted nipples. Clinical Lactation, 2-3, 30-33 Riordan JM, Woodly G, Heaton K. Testing validity and reliability of an instrument which measures maternal evaluation of breastfeeding. J Hum Lact. 1994;10(4):231–5. Belfort MB, Rifas-Shiman SL, Kleinman KP, Guthrie LB, Bellinger DC, Taveras EM, et al. Infant feeding and childhood cognition at ages 3 and 7 years. Effects of breastfeeding duration and exclusivity. JAMA Pediatr. 2013;167:836–44. Nabulsi M, Smaili H, Tamim H, Wahidi M, El-Jamal C. Validation of the Arabic Maternal Breastfeeding Evaluation Scale (MBFES-A) among Lebanese women. Int Breastfeed J. 2021;16:60.Participants were randomly allocated to the experimental or to the control arm in a 1:1 ratio. The random sequence was computer-generated by an independent statistician and concealed by using sequentially numbered opaque sealed envelopes. A participant’s allocation was revealed only after the research assistant obtained her written informed consent. Interventions Alexander JM, Campbell MJ. Prevalence of inverted and non-projectile nipples in antenatal women who intend to breast-feed. The Breast. 1997;6:72–8. https://doi.org/10.1016/50960-9776(97)90177-6. Use breast shells. Breast shells are sold at maternity stores and online. They are soft, circular discs with a small hole in the middle that pushes the nipple forward. [9] X Trustworthy Source Science Direct Online archive of peer-reviewed research on scientific, technical and medical topics Go to source We will randomly allocate eligible women to one of two parallel groups (experimental and control) in a 1:1 ratio according to a computer-generated random sequence. An independent statistician will prepare a set of sequentially numbered opaque sealed envelopes of the allocation group according to the generated random sequence to preserve randomization concealment. A participant’s group allocation will be revealed after verifying that the inclusion/exclusion criteria are met, and after written consent is obtained on the first day postpartum. This will avoid any selection bias introduced by the investigator knowing the allocation of the next subject. Description of the interventions Control group

Breastfeeding confers several health benefits to infants and their mothers, including protection from infectious and chronic diseases, improved child cognition, development, and intelligence, and decreased risks of maternal depression and malignancies [ 1, 2, 3, 4, 5]. As such, breastfeeding is recommended as the exclusive nutrition for the first 6 months of the infant’s life, with continuation until 2 years complemented with solid foods [ 6, 7, 8]. However, women with inverted nipples often have difficulties in maintaining breastfeeding due to improper infant latching that my cause insufficient milk extraction and poor infant satiety, thus leading to early termination of breastfeeding. Congenital inversion of the nipple, the most common nipple deformity, is due to early developmental arrest [ 9], with an estimated prevalence of about 10% [ 10]. However, nipple inversion can also be acquired secondary to mastitis, macromastia, carcinoma, or breast reduction, or can be associated with congenital syndromes such as Robinow and MR/MCA syndromes [ 11]. Han and Hong categorized the severity of inverted nipple into three grades. In grade 1, the nipple is easily pulled out manually, maintains good projection, and has minimal fibrosis. Grade 2 includes the majority of inverted nipple cases in which the affected nipple can be pulled out manually but fails to maintain projection and has moderate fibrosis beneath it. Grade 3 constitutes the rarest type of inverted nipples, which cannot be pulled out manually due to severe fibrosis [ 12]. New users typically wear Supple Cups for 15 minutes on the first day. If no pain or discomfort is experienced, one may advance the time each day, gradually increasing to four hours per day by the end of the first week. I capezzoli introflessi sono la conseguenza di un difetto anatomico rappresentato da dotti galattofori corti che trattengono il capezzolo. L'intensita' di risuzione e' controllata dalla donna che la regola secondo la sua sensibilita'. L'effetto di Niplette e' dovuto all'allungamento dei dotti galattofori che trattengono il capezzolo introflesso. Poiche' non si interrompono i dotti la funzione del seno non viene alterata e l'allattamento diviene possibile. MODO D'USOIt’s important that your nipples are completely drawn out before piercing. If they aren’t, your nipples may invert even after the jewelry is in place. Start by wearing the Niplette for one hour per day. Gradually increase by one hour each day, working up to eight hours per day. You may only experience inversion in one nipple, or even different grades of inversion in each nipple.