I believe that most mothers need the larger flanges. The Medela research 
on the Symphony showed something like 77% needed bigger flanges. I like 
the Ameda ones as they are 30 mm with an insert that makes it 27 mm. I 
almost always use the 30 as I feel bigger is better. Moms also tell me 
bigger feels better. I probably put most moms in a 30 but have maybe 
20-30% stay on the Ameda 25mm. The problem with Medela's first size is 
that it is 24 mm and this is pretty tiny. I would guess that if mom fits 
a small nipple shield, the 16 mm size, she needs the 24 mm flanges. I 
have heard that Ameda will make their standard flange the 27 mm which I 
think is great!! 27 should be the beginning size.

So to answer your question, I think that just going with the 30 mm for 
Medela is going to work fine for most ladies. I think few need the 27 
and they will do okay with the 30. Bigger is not a problem, too small is 
a huge problem.

I size by eyeball, just looking at mom. Sometimes she looks small, and 
we then switch to the 30 mm flange during pumping, depending on if she 
says it hurts or if she swells up too much. I do not like the nipple to 
touch the sides of the tunnel area.

My guesstimate is that if mom fits the 16mm nipple shield, the standard 
size flange is usually okay. If mom needs the 20 mm nipple shield or is 
"average" looking, chances are she needs a bigger flange. If mom looks 
like she needs the 24 mm nipple shield, she definitely needs the bigger 
30 flanges.

How to have moms "try out" a bigger flange? That is a good question. I 
would probably tend to just sell the 30's as my opinion is the Medela 
flanges are too small and the cone or angle of the flange is narrower 
than the Ameda and so moms tend to need the bigger one. Maybe you could 
have mom pump and dump with sterilized example flanges?

Kathy Eng, BSW, IBCLC

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