Literature review for - Flourish Paediatrics

Nipple Variationns
Search results
The initial search of the databases included 32 references on nipple variations including flat,
inverted or non-protractile nipples. Data were extracted from 7 references, and 3 studies
were used to form a body of evidence statement about the prevalence of nipple variation in
lactating women. The evidence was not strong enough to develop a body of evidence
statement for the effect of nipple variation on breastfeeding outcomes.
PREVALENCE OF NIPPLE VARIATIONS
What is the prevalence of nipple variation (at least one flat, inverted or non-protractile
nipple) in lactating women?
Draft Evidence statement
Draft Grade
Component Rating Notes
Approximately 8-10% of lactating women have at least
one flat, inverted or non-protractile nipple
D
Evidence Base Poor 3 studies; 2 cohort, 1 cross-sectional (1P, 20)
Consistency Satisfactory The cross-sectional study reported a prevalence 9.8%,
both cohorts found the prevalence to be 8%
Clinical impact Poor Nipple variation is a common problem experienced by
breastfeeding women
Generalisability
Applicability
Satisfactory 1 study conducted in New Zealand, 1 study conducted
in the UK, 1 study conducted in the UK
Satisfactory Results are applicable to Australian women
The studies included in the body of evidence statement are shown in the Table below
The cross-sectional study conducted on 3006 women in the UK found 9.8% (8.8, 10.9) of
women were found to have at least one inverted or non-protractile nipple. The study involved
trained observers conducting a ‘pinch test’ on each subject to determine the presence of
inverted or non-protractile nipples (Alexander and Campbell 1997).
A cohort study conducted on 350 mothers in New Zealand found 8% of mothers had inverted
nipples. The study does not detail how the prevalence of inverted nipples was determined. So
it is assumed the researchers used mother’s reports (Vogel, Hutchison et al. 1999)
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