Well, it is always difficult without seeing the mom actually pump...but can 
you try a 36 or 40mm flange?

These situations are very frustrating.  We see them once in a while...I can 
think of a handful in the past 6 years, most of whom just nursed on one 
breast.  We have two women currently who had previous lumpectomies with 
periareolar incisions from about 1:00-4:00 who are getting very little milk 
from that breast, and are from the other one.  But at least we have 
something to theoretically blame in those cases.

There is so much we do not know.

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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