Zena, I have a suspicion that the nipple changes with the pump and possibly  
the poor milk production has more to do with an incorrect flange size than an  
anatomical issue.
I would measure the mother's nipple and then the flanges.  This has  been 
something relatively new in the past couple of years.  When mothers  change the 
flange size they comment how much more comfortable the pumping is and  
therefore letdown with more milk.
Ann Perry, RN IBCLC
Boston, MA

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