Breast Shells

Breast shells are sometimes used to help correct inverted and flat nipples and are used to protect sore nipples. There are two plastic pieces that make a breast shell. The first piece is a flat round piece with a hole in the middle. This lays on the breast and the nipple fits into the hole. The second piece is dome shaped with small holes all over it to promote air flow. It snaps on to the first piece. The dome keeps anything from touching the nipple.

A study done in 1992 found that the use of breast shells for women with inverted or non-protractile nipples may reduce the chance of successful breastfeeding. BMJ  1992;304:1030-1032 (18 April), doi:10.1136/bmj.304.6833.1030

J. M. Alexander, A. M. Grant, M. J. Campbell
Department of Nursing Studies, University of Southampton, Southampton General Hospital.

OBJECTIVE--To determine the value of recommending breast shells or Hoffman's exercises, or both, to pregnant women with inverted or non-protractile nipples who intend to breast feed.

DESIGN--Randomised controlled trial with a two treatment by two level factorial design.

SETTING--Antenatal clinics in a district general hospital and the community.

SUBJECTS--96 nulliparous women recruited between 25 and 35 completed weeks in a singleton pregnancy with at least one inverted or non-protractile nipple.

MAIN OUTCOME MEASURES--Anatomical change of nipples, judged blindly before first breast feeding, and success of breast feeding reported by postal questionnaire six weeks postnatally.

RESULTS--Sustained improvement in nipple anatomy was more common in the untreated groups but the differences were not significant (52% (25/48)shells v 60% (29/48) no shells; difference -8% (95% confidence interval -28% to 11%) and 54% (26/48) exercises v 58% (28/48)no exercises; -4% (-24% to 16%)). 24 (50%) women not recommended shells and 14 (29%) recommended shells (21%; 40% to 2%) were breast feeding six weeks after delivery (p = 0.05), reflecting more women recommended shells both deciding to bottle feed before delivery and discontinuing breast feeding. The same number of women in exercise and no exercise groups were successfully breastfeeding (0%; -20% to 20%). 13% of women approached about the trial (and planning to breast feed) did not attempt breast feeding.

CONCLUSIONS--Recommending nipple preparation with breast shells may reduce the chances of successful breast feeding. While there is no clear evidence that the treatments offered are effective antenatal nipple examination should be abandoned.

This entry was added to the original BirthWiki by amyncarter on 20 Aug 2009.