""If the pressure of the opening of the flange tunnel falls in front of the
lactiferous sinuses during the pumping cycle, it tends to strip the milk
back upward, even resisting much of the forward counter-push of the MER
(to say nothing of placing schear forces on the delicate thin-skinned
junction of the nipple with the areola). Larger flange tunnels allow not
only the nipple, but larger parts of the areola and the subareolar
sinuses, to enter the tunnel. This allows compression to be focused not
only beyond the skin surface of the nipple-areolar junction, but also on
the middle, or the posterior part of many of the lactiferous sinuses that
may be somewhat deeper inside the nipple-areolar complex. This thereby
offers the kind of compression you would apply to the back of a
toothpaste tube if trying to empty it more completely.""

This is exactly what I felt was going on when I tried to pump, and while 
breastfeeding, at least part of the time, mostly due to nursing babies who'd 
had little pointy bottle nipples for days or weeks before they were placed 
for adoption.  I had tried virtually all of the best pumps that were 
available through the early-90s but the only one I was able to express more 
than a dribble of milk with was the little "Gentle Expressions" pump, more 
than the Lactina and the Lact-E.  I did have only a partial milk supply, 
using only the suckling to produce it, but my babies were getting at least 2 
ounces at a feeding, compared to about a half teaspoonful with most pumps.  
(With the GE, I could pump a "whopping" half ounce at a time!) The only 
explanation I have been able to find for that is that the opening to the 
flange part of the Gentle Expressions is a bit wider than the others.

I think this is a very important issue for moms to have guidance on!  
Especially considering the fact that so many standard flanges even come with 
smaller adapters!  I actually had smaller than average nipples, when my 
first baby was adopted, and thought I should use the adapter with the 
Kaneson cylinger pump I was told to use.  Besides the issue of the 
positioning of the lactiferous sinuses, pumping with too small a flange puts 
alot of stress at the base of the nipple.  I wonder how many moms have 
actually ended up weaning early on, because of nipple damage and/or 
discouragement from not being able to pump very much milk.  One can tell 
some moms over and over that the amount they can pump may not be anywhere 
near an accurate indication of the amount of milk their babies get from the 
breast, but never get them past the doubt that comes of pumping and pumping 
and not seeing near the amount of milk they expect or think they "should" 
get.

Darillyn

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