> Winnie writes:
> Medela has a "nipple guage" (not sure what it is actually called)
> with holes to match the various size shields they make.  On occasion
> when I have wondered if I was judging a nipple size correctly, I
> have used it and found it quite helpful.  Not only are the sizes
> correlated with thier flange sizes, but I think they are also given
> in mm's (mine is at work or I would check it for sure). so it could
> be useful for other brands if you know the mmm size of the opening.
> Of course, especially when a mon's nipples are close to two sizes,
> comfort should be the primary determinant, but a gizmo such as this
> can give you a starting point.
>

I was asked by Hollister to devise a similar "sizing tool" for its larger
nipple tunnel flanges.  However, I have some misgivings about this.
Perhaps the combined brainpower of Lactnet can help point me in the right
direction.

When I worked with mothers in my private practice (for 10 years), I found
that the size of a mother's nipple at rest did not always correspond to the
size nipple tunnel she needed.  About six months ago Dee Kassing noted this
in one of her posts.  In fact, she even observed that for some mothers, it
may take several pumpings to get a true indication of her correct size.
There appears to be an anatomical variation that I don't know the technical
term for (I call it "underlying tissue").  Many mothers with wide
underlying tissue have average-sized nipples at rest, but the standard
flange is not right for them.  When they pump, this wide underlying tissue
is drawn down into the nipple tunnel and rubs uncomfortably along the
sides.  When they use a flange with a larger nipple tunnel, pumping becomes
more comfortable and they get better results.

Perhaps I am making this more complicated than it needs to be, but I hate
the thought of coming up with a "measuring system" only to get justifiable
complaints because mothers end up with the wrong product.

My saving grace so far is that with the Hollister Custom Breast Flanges a
mother doesn't need to know her size before she buys them.  One package
includes two pump bodies (breastshields), each with an insert.  With the
insert left in place, this gives her the Large size (28.5 mm) and with the
insert removed, it is the Extra Large size (30.5 mm).  This means if a
mother needs a different size nipple tunnel on each breast, she is all set
and doesn't have to buy another product.

Back to the sizing issue, does anyone have any words of wisdom for me?  Do
you think that since a mother gets a "two sizes in one" package with the
Hollister product that a sizing tool is unnecessary?  And does anyone know
the technical term for this "underlying tissue"?  Thanks in advance for
your help.

Nancy Mohrbacher, IBCLC
Lactation Education Specialist, Hollister, Inc.
Chicago suburbs, Illinois USA

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