How I Do it? - Managing the problem of Inverted Nipples by The rubber band experience by Dr Kamalendu C

Managing the problem of Inverted Nipples
The rubber band experience
Dr Kamalendu Chakrabarti

I have been forced to do something I have never done and never dreamt of doing. And I was astonished to see the result. I want to share this experience with all the faculty members of BPNI.

A teacher, Farida (name changed), was referred to me by her doctor as she was having problems with breastfeeding. Farida’s baby was 21 days old and her nipples were unusually wide and deformed with multiple bud-like tiny swellings. She was eager to breastfeed but her baby was unable to get the nipple in his mouth. Farida started bottle feeding. That led to breast refusal.

At the first instance, I tried all the conventional methods for solving the problem. But time kept passing and all my acquired skills become exhausted. I started to accept my failure. My struggling with the baby, the nipple and the mother went on for about three hours. I was tired, disgusted and Farida’s condition was miserable. I had been overconfident that I could solve the problem, and now, realizing that my confidence was misplaced, I expected the mother to leave.

Farida’s husband had been a silent observer throughout. Suddenly he spoke out. His voice was no way pleasant. “Why you have wasted my time? Why you have manhandled my baby? Why have you made my wife confused and fatigued? You should tell beforehand that it is beyond your capacity.” He shouted.

I did not know how to deal with the family. The primary problem of breastfeeding became secondary. The problem became social, ethical and professional.

I timidly asked for another chance. I tried to make them comfortable, offered tea and snacks and went out in the open air.

I started thinking a fresh. Instead of thinking about the incident, I tried to think about the problem professionally and scientifically. Suddenly one idea came to my brain and I came back. By this time Farida’s husband was ready to leave the place. I requested them to give me a few minutes more. I took an ordinary rubber band, used in daily household purpose and with permission, I ask my lady attendant to apply the band around the base of the nipple of Farida’s breast. Then the baby was positioned properly and the magic began. To every body’s surprise, the baby stated suckling and smile was visible in face of the parents.

After seven days, they came again and thanked me. Farida fed her baby exclusively for six month and continued till the baby was about one year old. I requested them for one photograph but they refused.

The incident stayed with me, affecting me deeply. What I was forced to do as an act of desperation in an adverse situation, led me to work on it - to find out whether Farida’s case was merely one incident or had the rubber band really done the magic. I stated carry it though. Fortunately I got a few mothers with problems in their nipple.

Radhika (changed name) was a young mother without any breastfeeding knowledge. She had a very unusually big breast having nipples with very ill-defined margins. In fact, the nipples were buried underneath the breast and Radhika herself had search them out. Only a blurred black margin of areola was visible. After positioning, which was very difficult, I could not made the baby to suckle. Then I went for the rubber band. Again the magic prevailed.
Gradually, I started using the rubber band in other nipple conditions with success.

Here I am depicting some visuals.

Figure 1a condition of nipple of Dipika

Figure 1b condition of nipple of Dipika

Fig1a.b. Shows the condition of nipple of Dipika (changed name). As seen in the visuals, it was a clear case of gross inverted nipple; in fact nipple is not formed. Dipika had 11 day-old baby. She tried her best with the help of doctor to breastfeed. But she was completely unsuccessful. She was forced to start bottle feeding. I showed her proper positioning. I used INVERTED SYRINGE method, (which is a standard method) without any success. Then I went for the rubber band and the problem was solved.

Figure 1c. Shape of Dipika's nipple with band (manually applied)

Debashree had inverted nipple. As she had been given wrong advice, she started bottle feeding her baby since birth, leading to total breast refusal. INVERTED SYRINGE method was not successful. The problem was instantly solved with rubber band. Figure

Figure 2. Debashree's nipple with rubber band

Figure 3. Debashree successfully breastfeeding

The rubber band method

The indications of using rubber band are
• Inverted nipple
• Huge breast with ill-defined nipple
• Distorted nipple due injury, post-burn scar, etc.

Type of rubber band
Ordinary rubber band used for small package in shops will do. It should be washed thoroughly with soap and water. A few bands may be put together, wrapped with a piece of cloth and boiled for 5 minutes.

How to apply the band
Application of rubber band around the nipple is technically is slightly difficult. It is best applied by the mother herself.

Duration of keeping the rubber band during feeding
As such, the rubber band can be kept for the whole session of breastfeeding. But it is better to remove the band once the attachment is complete and baby starts taking the breast comfortably. It has been seen that most of the mothers prefer to keep the band for the whole duration of feeding. It sometimes becomes difficult to remove the baby from breast while they are feeding comfortably. There is no harm in keeping the band for the each session of feeding. No mother has yet complained of pain and discomfort with band applied. But the mother should be told to remove the band if she feels pain.

For how many days the rubber band should be continued to be applied
Depending on the condition of the nipple, the band is required to be used for two or three days. Then the condition improves and breastfeeding can be continued normally.

The standard method of treating inverted nipple with Inverted syringe has some problems. The nipple does not protrude after syringing in most cases. It has always to be done under medical supervision. It causes pain. In case of rubber band, the nipple stays protruded and though it is always better to done under supervision, once the mother learns the procedure, she may not require strict supervision. It is not painful.
The best method is drawing out the nipple with the syringe and then applying the band.

The risks of rubber band
There is possibility that the band might slip into baby’s mouth. But in the twenty cases, I have used rubber band, not a single one has slipped in.
The ordinary rubber band is probably chemically not suitable for use. However, because firstly it is cheap and other kinds of rubber bands are not available, secondly, the baby is not swallowing the band and thirdly it is used for a very shot period, the problem should be considered merely theoretical.

Using a rubber band is a very simple method of dealing with the nipple problem. I am still working on it. I am trying to devise a simple device to better application of band, am not able to make it due to lack of technical support.
My intention is to make a simple instrument as given in the figure below.


A syringe-like simple instrument as used in Inverted Syringe method without the wide base, which causes obstruction when slipping the rubber band over the nipple. The base should be smooth enough not to cause pain and injury to the breast.
Till such an instrument is available, a simple a 10 cc plastic syringe is a very good method for certain nipple conditions.

Finally, I worked on the issue more methodically and got it published in the BREASTFEEDING JOURNA, the official journal of ACADEMY OF BREASTFEEDING. THE LINK IS: - 'Management of Flat or Inverted Nipples with Simple Rubber Bands' (Breastfeeding Medicine)



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