Hi All,
	Just wanted to throw my 2 cents in on this topic, because disagree
with the statement that 'most' or 'all' women really need the larger flange
sizes.  I absolutely and certainly agree that there are many women who do,
and that it's very important for women to be using the correct size flange
for them.  I also agree that pre-measuring mom's nipples to determine flange
size is not very accurate.  I too have seen many women with 'small' nipples,
whose nipples quickly swell while pumping and need a larger flange, and
other women whose nipples hardly change at all.
	What disturbs me is what seems to be a trend of 'bigger is better'
as far as flanges go!  I get at least one call per week now of women who are
pumping and who have heard, or have been told, that using a larger flange
will help them get more milk. (No argument here, that if they NEED a larger
flange it WILL help with milk expression!).  However, often these women have
not been properly sized -- they've just gone out and gotten, or been given,
larger flanges.  When they call me, they're experiencing breast pain that
turns out to be bruising on the areola, resulting from delicate areolar
tissue being drawn into and squeezed into the flange.  I had one poor mom
recently who had relatively small nipples, who was using a 36mm Medela
flange!  She was 'still' having pain and wanted to know if we carried
anything bigger!  (This poor mom's entire breasts would have fit into a
larger glass flange!).  When a watched her pump, I showed her why the flange
she was using was WAY too big for her and how it was in fact damaging her
areolar tissue.  We tried different size flanges, and she ended up
comfortable and happy in a standard 24 mm flange.  She then broke down in
tears and said that she had been having milk supply issues early on and was
told that it would be fixed by using larger flanges!  When she had pain in
the next-size-up flange, she was told to go larger!  So, she finally ended
up with a 36.
	Had another mom with a similar story using a 27 mm., and looking to
buy a 30mm. when I convinced her to let me see her pumping and size her
properly, she ended up getting a 21 mm reducing insert and has been happy,
comfortable, and pumping tons.
	So, while I'm very happy that we have so many sizing options
available to mom, and I'm the first to let moms know when they need a larger
size, I get very nervous about blanket statements or recommendations that
moms should be automatically using larger sizes.  I know - this is NOT what
most of you meant!  :-) Just thought I'd chime in!

Best wishes,
Jeanne

Jeanne Cygnus, IBCLC, RLC
Cygnus Lactation Services
847 837-4091
www.cygnuslactation.com
 
 

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