Correctly Fitting Breast ShieldsMany pumping moms don’t realize that the flanges or breast shields they are using may not fit them properly. Ill fitting flanges can result in soreness, abrasions, edema, reduced let-down, and reduced milk supply. The size of shield you use is not determined by your breast size but is influenced by the diameter of your nipples and also the location of your milk ducts (some women’s ducts will be closer to the nipple and for others a little further back). While many women will benefit from larger flanges, there are others who will do better with smaller than standard size flanges. There are some general guidelines to help you determine if you may benefit from a different sized flange and whether you need larger or smaller flanges. Keep in mind that the nipple will stretch and change shape during pumping, so it is not always possible to determine the best flange size without actually pumping. You many need a larger sized flange if:
Needing to switch from a standard size flange to a smaller flange is not as common as switching up to larger flanges, but you may need a smaller sized flange if:
Other alternatives and options to try are silicone flanges such as the Flexishields by Ameda or the SoftFit and Comfort Breastshield by Medela. The Flexishields will reduce the diameter of the flange to 21mm as they fit inside the regular flanges and also provide increased nipple stimulation. I have also heard very good things about the Pumpin’ Pals flanges which are an angled insert that fits into the breast pump flange. Sometimes you will have to try and test out different flanges or inserts to find what will work for you. The benefits will be well worth it! 26 Responses to “Correctly Fitting Breast Shields” Leave a Reply |
 
 
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June 4th, 2009 at 2:02 pm
Thank you for all of your helpful information! I am pumping exclusively and I have a lot of nipple pain. I think some of these flanges may help! Thanks again!
Jessica
June 16th, 2009 at 6:01 pm
Those Pumpin Pals horns are the best thing ever, as far as I’m concerned. The angle makes it so you can pump without leaning forward. I don’t even use a hands-free gizmo — I just tuck them into my bra with a pad between the bottom edge and my bra, and they work like a charm.
June 17th, 2009 at 9:57 am
I have the pumpin pal flanges as well as the comfort and soft fit by Medela, and the Comfort flanges are by far the most comfortable and natural!!1 I highly recommend them for increasing supply and most of all for comfort!
June 22nd, 2009 at 12:54 pm
This is so interesting! I recently moved from nursing to pumping exclusively (due to an infection and subsequent return to full-time job). I have noticed that I’m not getting out much milk when pumping now (baby is 3 months old and I have been pumping exclusively for about 4 weeks). With the infection, I was hand expressing due to sore/cracked nipples. Now that I’ve returned to the breast pump, I’m not getting out nearly as much milk as before. I have large nipples and thus am using the size 36 mm breast shields. The left side does “ok” while the right size is almost nonexistent. I wonder if I need to go down a size on the right (right breast/nipple is smaller than the left breast/nipple). Or would these flanges work better? (I’m not sure if they’re useful for women with larger breasts.)
Thanks so much for any advice.
June 24th, 2009 at 4:27 pm
Hi Cinda,
If you have one nipple that is noticably smaller than the other, you may find pumping is more effective with two different sized flanges. You ask about “these flanges” and whether they work for women with large breasts. I’m assuming you are referring to the Pumpin Pals? They do make a variety of sizes and the website seems to suggest sizing is based both on breast size and nipple diameter. I have no personal experience with this type of flange, but have heard very good reviews from lactation consultants and women who have tried them.
I hope that answers your question. Feel free to email again, if it didn’t
June 30th, 2009 at 11:04 pm
My mom is a lactation consultant founded one of the first breastfeeding clincis in the country.
Based on her clinical work and published research on flange sizes an estimated 90% of women need larger than the standard flange size (24). Most women will need the size 27, a few will need the 31, and there is debate in the lactation community whether or not the smaller sizes are even necessary. Increasingly women are purchasing the smaller sizes, not understanding that they really need the larger size. This is leading to damaged nipples and very uncomfortable pumping/bfing. Keep these estimates in mind as you look for other size shields.
The pumpin pals are great, btw!
July 1st, 2009 at 9:35 am
Kate, you are absolutely right that many women do not realize they need larger flanges. Part of the problem is that breast pumps come with these “standard” size flanges which are indeed not the standard size of women. Information needs to be included with pumps to let women know that other sizes are available and often necessary. From personal experience, I can tell you that the smaller sizes are necessary in some cases. For me, switching to Ameda’s Flexishields which reduce flanges down to 21 mm made a tremendous difference to me and, I believe, allowed me to pump as long as I did. One size most definitely does not fit all and bigger is not always the solution- although statistically speaking more women will need larger sizes. Women must find the size that fits them.
September 5th, 2009 at 8:36 pm
admin,
Thanks for your reply to Kate. I too have found that I need smaller flanges, as was my experience with the MPIS.
I now have an Ameda PY pump and have started pumping full time at work and have very very sore areolae. But I certainly do not need larger shields as this would make my problem worse since almost my whole areola is pulled into the shield.
Did you really find the Ameda Flexshield helpful? I have read very mixed reviews…
Also, i ordered pumpin’ pals, so I hope they work.
September 6th, 2009 at 9:27 am
Hi Lulu,
I can only speak from my own experience, but I believe that had I not discovered Ameda Flexishields, I would not have EPed as long as I did or if I had, it would have been under great discomfort. They made a big difference to me. I had suffered pain and discomfort pretty much from the start and got little useful information on how to resolve the discomfort from the lactation consultants I spoke to. One even suggested that I should never pump for more than 10 minutes, which obviously is not an option for an EPing mom. I also think that the Flexishields provided more stimulation behind the areola which in turn helped to increase let-down and milk removal. I’m only one person, but for me they made a difference.
Best wishes,
Stephanie
September 10th, 2009 at 6:44 pm
Stephanie,
Thanks for your reply. I too have had little help resolving the pumping issue due to small areolae and nipples…
I had no trouble breast feeding, but pumping has been another issue altogether. My best experience so far has been with the Avent hand pump, I think due to the silicone “petals” insert, which reduces the size of the flange and stimulates the breast.
I will try pumpin’ pals tomorrow for the first time. If they are not helpful I will order the Flexshields.
Thanks again!
Lulu
November 4th, 2009 at 4:05 pm
Hello Stephanie,
I’m also having problems choosing the correct breast shield. I have tried the 24, 27, and 30 mm Medela sizes, and I have gotten progressively less milk with each size. I am pumping 8 times a day for 20 minutes, drinking my at least 64 ounces of water a day and am also taking fenugreek. The reason I switched from the 24 is that my nipple was rubbing the inside of the breast shield and causing pain, but the larger sizes produce less milk. Also, with the larger sizes I am able to express a large amount of breast milk by hand after I have gone through 20 minutes of pumping. Any ideas would be greatly appreciated!
Thank you!
Sarah
November 5th, 2009 at 3:58 pm
Hello. I was having terrible nipple pain while pumping with the 24mm flanges that came with my Medela Pump in Style. The reason I was pumping is because I have flattish “inverted” nipples and wasn’t able to breastfeed correctly. It is important to note that my nipples are not huge. I finally found this website: http://lactinv.com/breastfeeding_qna.php?article=proper_fitting_of_breastshields I was surprised to see that my flanges were too tight. So I upgraded twice and ended up with the 36mm XL size from Medela. My nipples feel better. I am concerned because with this fit almost my entire areola gets sucked in. If I am not having any pain, could the fit still be incorrect? I am going to a lactation consultant next week and will show her, but I would like to know if there is a standard. Thanks.
November 5th, 2009 at 5:03 pm
Hi Sarah,
This problem of breast shield sizing is so common! I think there is a misconception that the nipple should not touch the walls of the flanges at all. This isn’t the case once the pump is turned on. Prior to pumping, the nipple should fit comfortably inside the flange tube. Once the pump is working however, the nipple will usually swell and expand to fill the tube.
I believe there is a balance between a flange that fits the nipple and yet provides a certain amount of stimulation to the areola- pulling the entire areola into the flange tube is not the same as stimulating this area.
I would suggest you drop back down to the 27 mm flanges, provided they fit prior to starting the pump, and use good pumping techniques including using some type of lubrication when pumping and see how that works for you. Use lots of massage and breast compressions while pumping. You have already spent a great deal of money on flanges, so you are likely not wanting to buy anything else, but some of the softer flanges can be helpful in providing more stimulation and eliciting a letdown.
Hope that helps!
Stephanie
November 5th, 2009 at 5:03 pm
Hi Nancy,
While having flanges that are too small will usually result in pain and discomfort, having flanges that are too large can sometimes result in reduce milk supply due to a decrease in stimulation of the breast and areola. You do need to find a balance between the flange fitting the diameter of your nipple and maintaining some stimulation against your areola. When the areola is pulled into the flange tube, the stimulation changes and the duct that may lie under the areola area may get compressed and as a result, milk flow may suffer. Going from the 24mm flanges to the 36 mm flanges is a very big jump. The fact that your nipple pain has improved is great; be cautious of your milk supply though.
I think it is sometimes a misconception that your nipples should never touch the side of the flange tubes. Check the size of the flanges without the pump turned on. Once the pump is operating, a woman’s nipples will increase in size and enlarge often to fill the flange tube. It is important to use some type of lubricant to prevent excessive friction.
Hope that helps.
Best wishes,
Stephanie
December 7th, 2009 at 11:53 pm
Stephanie, I’m a first time mom of a full term 3 week old baby girl. Recently I decided to just EP. Last week, my nipples started becoming dry, cracked and scabby. In fact, everytime I took off my nursing bra, my nursing pads would have scab residue. Now, the area around my areolas are itchy and red. Could this be due to incorrectly sized flanges? I’m currently using 30mm size flanges on the Medela Symphony pump. Or, since I’m prone to contact dermatitis, could I be allergic to the breast pads? allergic to the plastic on the flanges or even allergic to my nursing bra? Have you heard of any other EP moms being allergic to any of these things?
December 14th, 2009 at 8:28 pm
I started out using the standard size breast shields, but I think my needs have changed. Do your nipples increase in size after a few months?
December 15th, 2009 at 11:56 am
Hi again Linda,
There could be a number of things going on in your case. It is certainly possible that you have some type of reaction to the flanges or breast pads. There is little you can do about the flanges unless you want to try switching to a different type. There are silicone flanges you can buy depending on the pump you are using. I believe Medela does make some glass ones, but I think they are a really large size.
If you are using disposable breast pads, you may consider switching to some reusable ones. You should be able to find ones made of cotton and some have wool layers to them (although if you tend to be allergic to things, you might want to avoid wool.)
It is important to use good pumping practices to avoid nipple/breast trauma. Ensure that you are not using excessive suction. Use the lowest suction that will work for you. In most cases, using the maximum suction does not result in more milk and in fact it can negatively impact supply and cause nipple trauma.
Are you using any type of lubrication? I highly recommend using something. The two most common are lanolin and olive oil. Again, lanolin may not work for you if you are allergic to wool and it should not be used if you have any concerns of yeast which would be my next point.
Given that you had a c-section I would assume that you were given IV antibiotics. It is common to develop a yeast infection/thrush on the nipples after having a large dose of antibiotics. This may be what is going on. Thrush usually presents as itchiness, redness, often shiny around the nipples and areolas, pain especially when first starting to pump (most often described as broken shards of glass being pulled through the nipple- ouch!), and pain in between nursing/pumping sessions as the breasts refill.
Try making the changes that are easy for you right now: change breast pads, use some type of lubrication while pumping, and ensure good pumping practices. You may consider adding a good quality probiotic to your daily schedule to help ward off a yeast overgrowth- good practice anytime you have been on antibiotics.
If things don’t improve or begin getting worse, I would seek out a consultation with both a lactation consultant and your doctor. You may need a referral to a dermatologist (be sure to find one that is breastfeeding knowledgeable/friendly).
Hope that helps.
Best wishes,
Stephanie
December 15th, 2009 at 11:56 am
Hi Stephanie,
I think it is very possible for your nipples to change in size and/or shape after pumping or breastfeeding for a while. If you find that your nipples are filling the flange prior to turning the pump on, then you may very well need to size up.
Best wishes,
Stephanie
January 25th, 2010 at 2:18 pm
Hi! Thanks for a very informative website. I am glad I found this resource. My question is–you talk about breast massage and compression while pumping. How exactly is this done? Thanks.
Lynne
January 26th, 2010 at 2:58 pm
Hi Lynn,
Breast compressions are done by placing your hands in a C hold with thumb on top of the breast and fingers underneath. Keep your hands well back from the nipple. You need to be placing your fingers behind the milk ducts which you will easily feel if your breasts are quite full of milk. Gently apply pressure. You can apply a slight forward movement as well if you find this helps- similar to hand expressing. You will often see a substantial increase of milk flow when you are applying pressure. Here is a video of Dr. Jack Newman’s showing breast compressions: http://www.youtube.com/watch?v=HJrBRYxDNSE It is with a breastfeeding mom, but the technique is the same and shows hand placement. You may find that by moving your hand around the breast to apply pressure in different areas, it will help to remove milk better.
Breast massage can be done with the tips of your fingers. Apply gentle pressure while massaging in a circular motion. Work around the breast. This technique is very helpful if you have any areas that are slow to release milk or blocked ducts. Here is a link to another video that shows briefly massage: http://video.about.com/breastfeeding/Breast-Feeding-Problems.htm
Thanks for your question! I hope this answers it fully.
Best wishes,
Stephanie
February 5th, 2010 at 6:32 pm
Where can I purchase the Medela comfort flanges? I have only been able to find them on websites for the UK. I would really like to purchase them but do not want to pay the shipping from another country.
Also, during my pumping sessions my nipples get close to touching the end of the flanges. They have gotten increasingly closer as the weeks of pumping have progressed. Do I need to change size of shield I am using and if so, do I need to go up or down a size?
Thanks for the great site and wonderful information.
Christy
February 8th, 2010 at 9:19 am
Hi Christy,
My best advice would be to email or call Medela directly and ask them where to find them. I have had another email about the same issue; perhaps Medela is no longer selling them in North America?
With regards to your question about flange size, if your nipples are not touching the end of the tube and are not causing any pain/discomfort, then you are likely okay with what you have. The length of tube doesn’t change when changing the diameter of the flanges, but going up a size will allow more of the breast tissue to enter the tube and will like fill it more. If this is a problem, I would suggest dropping down a size, provided that the diameter of flange will still comfortably fit your nipple size.
Hope that helps,
Stephanie
February 10th, 2010 at 5:29 pm
I tried all of the Pumpin Pals sizes. I also tried ALL of the Medela sizes. My nipples never became pain free. I can only wear my pump/nursing bra and feel uncomfortable just wearing a bathrobe before I got dressed. They have always hurt and I even went to a dermatologist. I tried a steroid cream (even though I know my baby was getting some in her milk)and got a little bit of relief, but only for a couple days. I also got my pump pressure checked at a lactation store here in Philly. I have also been fitted by a lactation consultant (even thought I have also tried all of the sizes.)
I then decided to quit pumping, but have only been able to cut down to 3 times a day since it takes so long to wean off the pump. I do feel a little better at 3 times a day, so I am considering staying at that rate. Right now the baby is getting 2 ounces of milk and 1.5 formula, which I have come to terms with! Have you ever heard of someone with this kind of pain? (When I say “pain” I am referring to: redness, occasional blisters, and a chapped appearance on the skin; very tender; sometimes bleeding. Pain when pumping and also pain in between pumping.)
Well, I hope that wasn’t too much information. I have just been googleing and not finding anyone else like me. I really liked the idea of pumpin pals, and I am sure they would have helped if I hadn’t already been so far gone.
IF ANYONE FEELS LIKE ME PLEASE EMAIL ME AT PUMPINGPAIN at GMAIL dot COM. I am considering starting a blog just for women in pain. Maybe we can help each other. I know nipples are vastly different, but if there are only 10 of us we can give each other advice.
Nancy
February 11th, 2010 at 10:19 am
Hi Nancy,
I’m sorry to hear about all the pain you’ve been suffering through! Sounds as though you have tried many things to solve the problem. I completely understand where you are coming from. I, too, suffered a lot of pain during the year I was pumping. I am naturally one of those fair, sensitive skinned creatures who gets a rash just thinking about regular soap and in part I think this does play into the pain some women experience when pumping. But it doesn’t solve it all. I also suffered with a yeast infection early on and I’m sure this likely set up a cycle of pain. Although again, doesn’t answer it all.
I think the size of flanges are important but not as important as some would like to think. One aspect that is often overlooked is the pump you are using. I try not to mention brand names too much on the site, but I will say that I used the Avent Elite pump for the entire year I pumped- I really liked it. I did try to switch to one of the other leading brands of pumps part way through the year because I could have rented it at a much cheaper rate, but I could only last two pumping sessions. The pain from that pump was so extreme!! So the pump definitely makes a difference.
There are lots of conditions that can be a cause of pain such as Raynaulds, eczema, contact dermatitis, sensitivities and allergies, even staph infections are quite common and often not tested for (and if you’ve had any type of trauma to the nipples, it opens you up for the introduction of infections such as this).
Ultimately, our nipples were never intended to go through the abuse a breast pump places on them. A nursing baby doesn’t suck on the nipple but instead latches onto the breast tissue and draws the nipple far back into the mouth where it isn’t hitting any harder than the soft palate.
Finding a knowledgeable doctor and dermatologist can be helpful, but they have to be breastfeeding knowledgeable and breastfeeding friendly.
Not sure anything here will be helpful to you, but you should be very proud of yourself for going to such lengths! You are doing great!
Best wishes,
Stephanie
March 12th, 2010 at 4:05 pm
Does anybody know if the pumpin pal things will work with a mi pump First Years double electric pump? That’s the kind that i have and i HATE that i have to hunch over to pump, my back is starting to protest VERY loudly. I usually don’t have any pain, and when i do i know its b/c i have it positioned a little funny. I also use a little bit of Lanisoh everytime i pump and that has made a world of difference. I also never even knew that you could have different size flanges! GREAT information.
March 19th, 2010 at 9:57 am
I am so glad that I found this website! I have been EP for the past 1.5 months. I tried to breastfeed, but had so many problems, from plugged ducts, engorgement, to mastitis. I finally gave up but still wanted to provide breast milk for my baby, so switched to EP (6-7 times per day). It’s been a lot better, no plugged ducts or infections, less stress; however, I still have a problem with my right breast. (My right nipple/areola is slightly smaller than my left one.)
Even though I had just started EP a month ago, I have actually started pumping since my baby was born. At the time I used what came with my madela pump in style, 24 mm, and it worked just fine for both breast. My right breast even produced 2oz one time! But then the milk from the right breast was slowly decreasing, and eventually after a couple of weeks or so, no more milk coming out, but I know there was milk there, since a couple of days later, I got bad enggorement from that breast.
Then I found out about the sizing, so I changed it to 21mm. At the time, my right breast was almost weaned off, because I couldn’t get any milk out. After using the smaller size, the milk start coming out again (even though only .25 oz on average), and it felt more comfortable. I was so happy. However, every now and then, this breast will be acting up again and no milk is coming out. It’s been 3 weeks like that, and now the milk has stopped for 2 days, which is very concerning. Usually it will back to normal again after 1 day. Also my right breast is now very full, I can feel some plugged ducts.
I will try the pumpin pal tomorrow, I really hope it will works. I tried to get medela comfort, but it doesn’t seem to be sold in US.
Again, thank you so much for such an informative website for EP moms!