Is nipple pain and damage caused by your nipple height or your breast anatomy?
Many different elements of your and your baby's anatomy interact together in breastfeeding
You and your baby are a biological system, with myriad different elements of the system interacting together during breastfeeding. Anatomic variations are just one part of the picture. If there's one thing that characterises both mother and baby anatomies in breastfeeding, it's just how variable we are as humans!
It seems to me that the current tendency to pathologise anatomic diversity and blame either the mother's or baby’s anatomy for breastfeeding problems has come about because our health systems lack effective clinical approaches which stabilise baby at the breast across the whole range of glorious anatomic diversities which are normal for humans!
Some anatomic variations have been linked with more breastfeeding problems
It's true that some anatomic variations of breast size and nipple height, though poorly defined, have been shown to have links with breastfeeding problems including nipple pain. These handful of preliminary studies suggest links between lower nipple height and larger breast size with breastfeeding problems. You can find out about these four studies here.
To my mind, though, these studies simply demonstrate how important it is for women to have strategies which eliminate breast tissue drag and help baby draw up as much breast tissue as possible into her mouth, regardless of our glorious human anatomic variability!
Recommended resources
Is baby having trouble coming onto your breast because your nipples are 'flat'?
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Anatomic factors which interact to affect how your baby sucks at the breast: an overview