I have a mom who delivered 27 days ago.  Her infant was 41 weeks and is now 45 weeks.  She began pumping immediately after delivery with a Symphony in the hospital.  She started with #24mm shields.  She changed to #27mm once home after a week of pumping due to breast pain and her nipple being compressed.  Her nipple size at the time was large and filling up the #24mm shields. She pumped with the 27's for a week(milk volume has always been great, 4-5oz each session, every 3 hours, with a 4-5 hour stretch one time at night. After a week she increased her shield size to #30mm on her own and then increased to #36mm at week 2 on her own.  Upon my assessment, her nipple size was still large and swollen in the 30's and she had an open wound on the base of nipple from rubbing,so I agreed with her increase to 36mm and treatment of the open area.  After a week of pumping with these, she still c/o pain with pumping despite using pre-pumping measures of Lansinoh or olive oil on the shield, warm compresses, and massage.  Her volume started decreasing and she was experiencing plugs in one breast after about 4 days. Her areola was bruised, and now more breast tissue than just nipple was pulling into the cylinder.  the nipple shape was no longer a defined separation from the breast. Even at rest. We re-evaluated shield size and found the #27mm to be the better fit now.  Her volume is back up to 3-4 oz a session, however she continues to c/o pain with pumping. When pumping it appears that more She is currently being treated for a yeast infection on her breasts with Diflucan and Clotrimazole Cream as infant also has a yeast rash in diaper area.  At week 2 the infant began breastfeeding with a nipple shield due to not being able to latch to the bare breasts. She continues to offer the breast 4 times a day with a f/u supplement and pumping.  Her infant is having difficulty with his suck so is unable to complete a feeding at the breast yet.  
Today I just watched her pump again and her nipple/areola area is very swollen after pumping.  I would like to see what the #24mm sheilds will do with her next pumping.  I am baffled!  If anyone has suggestions I would greatly appreciate the suggestions.  I can give more info as needed as well.  Thank you in advance.

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