75: You Are (Probably) Pumping with the Wrong Flange Size
(Measure the diameter of the nipple as a starting place.)
Key Points
Pumping should not hurt, and comfort is key.
Many women overestimate their nipple size, often needing smaller flanges.
It isn’t uncommon to need a different size on each breast.
Proper measurement of the nipple is a first step for flange sizing guidance (but not the only step!).
Too large or too small flanges can cause discomfort and tissue damage.
Maymom Flanges offer a wider range of size options if needed.
Flange inserts can be a solution but may require additional lubrication.
Wearable pumps may not work for everyone; comfort is paramount.
Adjust pump settings if discomfort occurs during pumping and you are certain you are using the correct flange size.
Consulting a lactation consultant can provide tailored support.
Let’s talk about flange sizes and how most women are pumping with the wrong flange size. Firstly, I just want to emphasize that pumping should not hurt. Period. It should not hurt. Now maybe, you don’t love it (I don’t know many mothers who do). But there should be no pain, no body tension while bracing for the pump, and certainly no nipple damage from pumping.
Surprisingly (or unsurprisingly), popular personal use pumps do not come with more than a few flange options which are almost always larger than the average woman’s nipple. For example, it’s common to receive a 21 or 24mm flange, but many women are closer to 17mm in nipple diameter. The other common issue is that mothers are being recommended to measure their nipples, then size up from there. This may even be recommended in the pump’s instruction manual. Lot’s of lactation consultants are not seeing this work well when it’s time to pump. Of course you don’t want a flange that is too small, however some gentle stimulation to the side of your nipples in the flange may not only be more comfortable but also result in more efficient and effective pumping.
What happens when the flange is too big, is the areola or breast tissue around the nipple base get pulled and tugged into the flange which is not only uncomfortable or painful, but can also cause inflammation and possible tissue damage!
So when measuring, use a ruler and a second set of eyes if you can to measure the diameter (side to side, straight across the nipple) in millimeters. This will not include the areola or darker area that flares out around the nipple, but only the nipple. This measurement gives you a great starting point. After that, it’s trial and see. Which is most comfortable (almost ignorable sensation wise)? Which causes the largest spray or milk to come out when the pump provides suction? These are ultimately the most important when it comes to knowing your best flange size.
Keep in mind, if you have nipple inflammation from latch or pumping trauma it is possible you need a slightly larger flange until things settle down. But if this is you, I hope you are working with a lactation consultant who knows her pumps and has good experience looking beyond the manual.
If you got your insurance covered pump and realize the flanges are way too big for you but your pump company doesn’t make small enough options you can try Maymom flanges (M-A-Y-M-O-M). They sell a larger range of sizes and many are compatible with other pump brands (but do check before you buy).
Flange inserts are also sold, usually silicone based which also provides mixed results. Some moms love them while others need a little coconut oil or something to help reduce friction that silicone tends to add.
Some moms pump with the provided flanges and do perfectly well with no issues. But comfort, efficiency, and avoiding unnecessary roughness with breast tissue should be prioritized in my opinion. So if you have any concerns at all, I would look into the flange size.
If you are trying a wearable pump, there are unfortunately not many options here and although sometimes creativity works, theses pumps not only don’t work for a large percentage of breasts but they require suction onto the breast while at the same time are being pressed into the breast tissue….so I am not a fan currently. However, if they work great for you please don’t give up what’s working.
If you know you’ve nailed the flange size then it’s time to look at the pump, the suction level settings, and adjust accordingly. Because again, pumping should not hurt. If you want some help on this I recommend seeking a lactation consultant (usually covered by insurance) to help narrow down some trial and error options. If you feel there isn’t one in your area well trained for this, I am going to link to two who offer virtual appointments to support pumping mothers with lots of experience.
Virtual pumping help resources:
Feed with Love: Cat Halek, IBCLC
Babies In Common pumping/feeding resources for parents
If you have a question for me, just shoot me an email. I’d love to hear from you. And please rate this episode so more moms can learn about flange sizing- this is a big area where outdated information is still everywhere and our nipples deserve better!