They manufacture a 21 mm flange that fits the connectors.  I have used these on a few moms, and they work well with some.  I like the soft flanges, especially in moms whose babies are older and back to work.

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Thursday, March 19, 2009 8:53 PM
Subject: Flanges

 I attended a conference that included a presentation by a Medela rep and addressed pump flange size. The hospital I work for has Medela pump kits that include 24mm flanges. The speaker specifically stated, and I quoted this in my notes, "...approximately 75% of all mothers who pump will require a size other than the standard 24mm at one point or another."? She also stated they no longer make the device that was formerly used to size flanges as after put to use they recognized that one could not appropriately determine what size flange a mother will need by measuring her nipple. The flange size is more related to the tissue elasticity. Which as we know, can change quite dramatically from day 1, to day 4, to day 14 and so forth.

She reinforced (and I agree) how necessary it is to observe the mother pumping. Sometimes you can see the friction of the nipple tissue within the flange tunnel immediately, yet if there is no friction immediately evident, if you observe the pumping after some time, the mother's nipple may swell due to the increased circulation, and although initially it appeared as though there was no friction evident, after 10 minutes the nipple is compressed within the flange tunnel and experiencing quite a bit of friction. If you do not have an opportunity to witness the mother pumping I would give her education related to what to look for and resources for obtaining larger sized flanges if she does experience friction of her tissue. We stock the alternative sizes on our unit and will provide the patient with the appropriate size when warranted.

The speaker also reinforced a mother may need different sized flanges for each breast. I make it part of my practice to observe the mother pumping to evaluate the flange size when feasible. I can't tell you how many mothers have thanked me for providing them with the larger, more comfortable flanges when they've been pumping with an ill fitted flange.

Sometimes going smaller might be more suitable, however to the best of my knowledge Medela doesn't appear to manufacture that insert device they used to make to slip into the flange that decreases the tunnel size and better isolates the nipple tissue?? Anyone?

Michelle H. Kinne ICCE CD(DONA) CLE
www.DoulaDiva.org










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