Several questions come to mind:
1-Is she trying to use the pump at highest setting?  It should be
the highest THAT IS COMFORTABLE FOR THE MOM.  Going higher than that
doesn't yield more milk.
2-Has she tried "lubricating" the flange?  I have found this to be
helpful for some moms.  Just a few drops of expressed milk on the
inside of the flange allows for a little movement of the breast
whereas when it is completely dry, there may be a tendency to pull
on the healing skin.
3-Does she have the nipple centered in the opening?
4-Is the edge of the flange just pressing in on the breast enough to
make a seal and is it the same all around?  Sometimes moms press the
flange in so as to make a big "dent" in the breast swhich may result
in greater pulling on the nipple.  When one side of the flange digs
in it may create a greater pull in one direction (as well as
increasing likelihood of not emptying well in that area of the
breast).
5-What about hand expression?  That shouldn't put the same kind of
tension on the healing area.

Winnie

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