Nipple measuring tools for breast shield or “flange” sizing have been around for years, but lately they’ve been popping up all over social media as a sure-fire way to perfectly fit for breast pump flange size. The tools range from complicated calipers to notched rulers to plastic cards with a sequence of larger holes into which nipples are inserted. Here at the Pump Station and Nurtury, our IBCLCs are increasingly fielding calls and meeting with moms who have used the tools, moved to a flange size much too small and are coming to us with nipple pain and damage and decreased milk supply.
We’d like to caution against their use as the sole way to fit yourself for a pump flange and here’s why:
Nipples and breasts come in all shapes and sizes…and elasticities.
The diameter of the nipple at its resting state, even after pumping, in no way represents the size the nipple becomes during pumping (or breastfeeding). Nipple skin is very stretchy and can increase in length and diameter more than 50% during pumping and feeding! It’s important to have someone with flange sizing experience watch you pump in order to accurately make a recommendation. If you can’t see someone in person, it can be helpful to try different flange sizes until you find the one that is most comfortable and that yields the most milk. Remember Goldilocks? If she had been a pumping mom, she would have tried 3 different flange sizes until she found one that was just right!
The measuring tools are inconsistent and confusing.
One company makes a downloadable ruler with notches into which the nipple is placed for measurement. They claim that,“The best size will fit easily around your nipple, but be quite snug leaving no room for the nipple to stretch in the flange.” (OUCH!)
Another newly popular tool asks moms to place nipples into differently sized holes in a plastic card. Again, nipples and areolas stretch, and how much they stretch ranges widely from woman to woman.
Flanges that are too small can result in skin damage and lowered milk supply.
Yesterday, I met with a mom who came to me with new breast pain and skin damage and lowered milk supply. She had been pumping comfortably for months, but a friend had tagged her in a social media post recommending a flange ruler. She used the ruler and switched from 24 mm flanges to 19 mm flanges. After using the new flanges for a few days, she developed painful semicircular wounds around the base of her nipples. During our appointment, she moved back up to the 24 mms, greased the flanges with a bit of Motherlove Nipple Cream and she was back in business!
A small amount of areola in the flange tube is OK!
Breastfeeding infants take a large mouthful of breast when they latch. (That’s why it’s called “breastfeeding” not “nipplefeeding”). When pumping, you might find that you pump more comfortably AND get more milk if a small amount of areola can move comfortably into the flange tube. Greasing the flanges with a small amount of a lubricant such as Motherlove Nipple Cream, olive oil or coconut oil can also help. We don’t recommend lanolin as it is too tacky and can cause the skin to pull and stick to the plastic.
There is NO research to support the use of these tools.
There is AMPLE research that advice from an experienced lactation professional will make pumping more comfortable and will yield higher milk output. Give us a call for a flange fitting appointment. We’re happy to help!
Allison Mahurin, IBCLC, BS
Allison Mahurin, IBCLC, BS