Lisa,
Regarding your Asian client, I couldn't tell from your message how large her
breasts were, or how large (in circumference) the nipples.  However, I had an
Asian client whose nipples were very long, and thick, essentially filling the
baby's mouth, so he could get very little areola in.  Consequently he had
trouble removing milk, especially from one breast (the other nipple was
slightly smaller, and that seemed to make all the difference).  The pumps did
not seem to work well because her nipple filled the entire breastshield, and
so not much could be drawn into the breastshield with suction.  We ended up
using a extra large glass breastshield put out by Med...., and that seemed to
work OK.  She bought two for double pumping at work, and as the baby grew he
began to accomodate her large nipples and was nursing more effeciently.
Elaine Webber