I was just asking the colleagues the same question on the Limerick!

Has she tried larger flanges than the 27/28?   Nature never thought about us pumping, and so a lot of people have to experiment -- some people pump with a flange that is "too big" but it's comfortable and productive.   The Medela website's picture on sizing flanges looks tight, especially if the mother thinks that's how it should look before pumping -- and some nipples really expand a lot with suction.

Some mothers have a somewhat conical nipple -- that the nipple shades into the areola, so perhaps it's hard to tell where one ends and the other begins. Sometimes the Pumpin' Pals is helpful  with that anatomy, and sometimes just a bigger flange that moves enough tissue.

Margaret Wills, IBCLC, Maryland, USA
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