All About Elastic Nipples
Updated December 2021 (Originally posted March 2019 and Updated May 2021)
Questions about elastic nipples are one of the top questions my clients using a breast pump ask. This is a popular term in social media groups that support breastfeeding parents, but it is also a widely misunderstood term.
So what is an elastic nipple?
An elastic nipple is a nipple that stretches more than we would typically expect when pumping. That is it, we are just talking about how much the nipple can stretch.
How do you know if you have an elastic nipple?
If an elastic nipple is one that exceeds the expected stretch of the nipple that would be considered normal. To find the expected stretch of the nipple we need to consider how the nipple functions when directly nursing as that is the biological normal function of this body part. When directly nursing the nipple can and should stretch 2-3 times in length, and given the average length of the nipple shank is between 10-12 mm we should the nipple should be able to easily stretch to 20 to 36 mm without significant concern.
So why are elastic nipples such a focus in the pumping world?
Simple, many pump flanges are very short and can not handle the stretch of a normal length nipple at it’s full capacity for normal stretching.
So how can I tell if my nipples are elastic?
If your non-swollen, undamaged, pain-free nipples, stretch more than 3 times in length when pumping with a flange no more than 2-4 mm from your pre-pumping nipple measurement, you have elastic nipples.
So what does that mean for you when you are pumping?
All elastic nipples means with pumping is that we may need to take a closer look at what style of flange will work best for you, and to find the fit that will accommodate the natural stretch of your nipples?
Let’s talk some more about how to understand normal and elastic nipple tissue:
There is nothing about elastic nipple tissue that is inherently abnormal or concerning. When directly nursing nipples actually swell and stretch within the baby's mouth filling the space between the palate and the elevated tongue, which would make elastic nipple tissue a benefit to achieving a pain free latch. Mothers are often unaware of the elasticity of the elasticity of their breast tissue if they are not using a breast pump. Elasticity really only gets discussed with direct nursing in regards to flat or inverted nipples as these mothers may have lower than average elasticity which results in nipples that do not protrude as easily, and getting the nipple to the safety of the baby's soft palate is more difficult.
When it comes to using a breast pump, elastic nipples can be quite challenging. The elasticity of the breast tissue makes getting the appropriate sizing difficult as the nipple will swell to fill any flange tunnel, making the traditional method of fitting based on post-pumping nipple size useless and possibly damaging. There is an idea in breast flange fitting that the nipple should not make contact with the sides of the flange during pumping, therefore if the nipple touches the sides of the flange at any time (even if there is no nipple pain, damage, or issues with adequately emptying) the mother needs to size up in her flanges.
I have assisted several mothers with higher than average elasticity who have suffered extensive nipple damage as a result of sizing up to the point their nipples did not touch the sides of the flange, but to achieve that, they were using a flange 10-15 mm larger than their nipple size. Their areolas were being sucked into the tunnels, they had inadequate emptying of the breasts, and they had significant pain and damage.
So is it safe to have the nipple touch the sides of the flange during pumping?
Take a look at this video showing how the nipple is compressed, stretched and stimulated during nursing. This direct stimulation of the nipple triggers the release of oxytocin, the hormone responsible for triggering the milk ejection reflex, also known as the let down. This ultrasound was used to generate a fantastic rendering of what is going on during nursing, and I am confident that we can extrapolate from the intensive stimulation of the nipple seen here that if the nipple touches the sides of the flanges, and there is not pain or damage, this is a safe practice. We need to shift our focus to achieving a flange fit that achieves adequate emptying, painless pumping, and doesn't cause complications, regardless of how that fit looks.
The biggest challenge with elastic nipples is finding the right size and style of flange. If you have been using the wrong size flange the edema in your nipples could complicate sizing, and require sizing down multiple times as the swelling is reduced. Traditional hard plastic flanges come in sizes ranging from 13mm- 40mm, and for most mothers there is a size in these flanges that will provide the comfortable pumping experience we are aiming for.
For some mothers with higher than normal elasticity these flanges have one big drawback with that hard plastic ring where the funnel meets the tunnel. These mothers will have areola tissue pulled into the tunnel no matter the size, and that ring serves as a choke point. The milk ducts become compressed, preventing the breast from emptying, and ultimately leading to lowered milk supply. The areola becomes bruised, and there may be tissue damage and pain. For these mothers I suggest the issue is the style of flange, not so much the sizing of the flange. Thankfully we have several alternative styles of flanges to turn to in order to achieve a painless and effective pumping experience.
Check out all of the options available to assist with comfortable pumping with elastic nipples! If you are struggling with pumping, I recommend working with a lactation consultant to get a proper nipple measurement and assessment of your personal anatomy to help you find the best solution for your goals.
Limerick Sof-Touch Flanges
www.limerickinc.com
Limerick Inc. manufactures hospital grade multi-user pumps, as well as a hand pump, that utilizes a 100% silicone flange. The flange compresses with suction to stimulate the nipple and areola much like nursing a baby would. A unique feature of the Limerick Pumps is that the pump uses continuous negative pressure suction. These features combine to create a pumping experience that is more gentle, effective, and faster than pumping with a standard pump. While these pumps are more expensive than many on the market they are made with high quality materials, and the parts do not require replacement as often because of the higher quality. Limerick flanges are a one size fits all approach, as the tunnel collapses to stimulate the nipple and areola, similar to the baby's mouth.
The use of a 1-micron filter on these pumps prevents milk from reaching the motor and contaminating the pump, making the limerick pumps safe for resale. You can often find these pumps second hand for between $100-$200 dollars. You would need to purchase a Sof-Touch kit to utilize a used pump, as the kits are single user. The Sof-Touch kit is not compatible with non-limerick pumps, and other companies pump parts are not compatible with the unique Limerick pumps.
If you are unsure of whether you would like the silicone flanges I would recommend purchasing the hand pump, I have personally found the Limerick Hand Pump to be as effective as the standard electric pumps on the market in a fraction of the time. The lower cost version of this brands signature pump, the PJ's Bliss, was rated as one of the best breast pumps on the market. The PJ's Bliss has been discontinued, but this review highlights the positive attributes of the whole line of Limerick Pumps. This pump is particularly fantastic situations with scar tissue or skin irregularities on the nipples. I have also seen great success with using this pump for mothers who have already experienced significant nipple trauma as it provides gentle pumping to maintain the milk supply, while allowing their nipples to heal.
Pumpables Liquid Flange Kit: Save 10% with this link or the code SHOP10-JZFMQS
Pumpables has come out with a liquid flange kit, where the hard plastic flange has a one piece flexible silicone insert that collapses with the suction of the pump. This flange requires the Pumpable tubing, however it fit the Spectra and Medela Pumps and worked properly. Pumpables Liquid Flange kits are compatible with Pumpables brand breast pumps, as well as a wide variety of pumps. Any pump that can use replacement Spectra tubing can typically be set up to use this pump.
This is not a one size solution, but comes in sizes 17, 21 mm, 25 mm, and 29 mm. If you are smaller than a 17 the collapsing tube would likely allow for use down to a size 13 mm, but smaller than 13 mm would be unlikely to effectively stimulate. This flange setup removes the issue of the hard plastic ring, and increases the stimulation to the nipple in a comfortable fashion. You should be sized for this option, but the flexible silicone doesn’t follow traditional sizing methods, and your size with these may not reflect your sizes with standard flanges. You may ultimately need to trail 1-2 sizes to determine which fit is most comfortable and effective for you. The quality of the parts feels nice, I expect them to last a fair bit of time.
This setup decreased the time I needed to pump to effectively empty from about 20 minutes, to 12 minutes. The liquid silicone inserts did not grab at my skin, but they did create enough suction that I was able to securely use them with a regular nursing bra. This is my favorite set up for hands on pumping as the flange shape is easy to maneuver around for massage.
LacTeck Baby Motion Flanges
www.lacteck.com
LacTeck Baby Motion Flanges are a heavy silicone flange, with no hard ring to constrict the breast tissue. The unique thing with these flanges is the addition of a thinner silicone window as the part of the flange you would consider the tunnel, that collapses with the suction to stimulate the areola.
These flanges come in a size 18mm, 21mm, and 24 mm. They are fantastic for elastic breast tissue as the provide additional stimulation to speed pumping (huge help with elastic nipples), and there is no ring to create a choke point and cause the trauma. You do need to be sized for this option.
A huge perk to these flanges is that they can be used as inserts in the freemie cups, spectra cups, and willow breast pump! You can get the benefit of this comfortable flange while getting the freedom of these wearable pump options.
BeauGen Cushions
BeauGen Cushions are soft pliable silicone intended to reduce the friction of the nipple against the flange tunnel, and to hold the areola back and out of the tunnel. Many mothers report these cushions are game changers for them, but others report they are painful and reduced milk output.
Remember the video of how the nipple is stimulated during nursing? For some mothers the beaugen cushions actually reduce the motion and stimulation of the nipple too much, which causes significant issues. BeauGen Cushions also have a slightly sticky texture, meaning the do pull at existing nipple damage which can be painful. If you are using BeauGen Cushions you need to be mindful that they reduce the sizing 1-2 mm, which can change your overall flange size. Trying to use them in a flange with only 2-3 mm of clearance would make the flange too small.
Pumpin Pals
Pumpin Pals are a variation on a traditional flange, that removes that problematic hard plastic ring by creating a tapered funnel. They comes in 5 sizes, but their sizing is unique and often doesn't correlate to your traditional sizing. Sizing for Pumpin Pals is roughly as follows: XS 15-19, S 20-23, M 24-28, L 26-30, XL, 31-40.
Silicone Pumpin Pals can be a great option for elastic nipples, if you put them on correctly. Here is a video showing how to put the silicone pumpin pals on.
These flange are a great option for mothers who are prone to clogs, or have longer nipples that need the extra flange length to be accommodated.
What about Traditional Plastic Flanges?
Traditional Hard Plastic Flanges can be problematic for elastic nipple tissue for two reasons:
1.) The length of the tunnel may be too short.
2.) The internal hard plastic ring where the funnel meets the tunnel in the flange design can pinch elastic tissue.
If you want to try a hard plastic flange your ideal size is determined by measuring your undamaged, not swollen, not painful nipple prior to pumping. Typically you will need a flange 0-4 mm from the base nipple size, with the average measurement being 2 mm. The true trick here is making sure you end up in a flange the right size and shape for your individual anatomy.
The flanges I have found to most often work for elastic nipples with success are the nenesupply hard plastic two piece flanges. If you need a flange between 17 mm and 27 mm (which covers the majority of pumping parents) and wish to try a hard plastic flange these are your best bets.
Elastic Nipples with the Elvie Pump
The Elvie Pump does pose some challenges with elastic nipples overall as the base flange length is only about 30 mm. Maymom and Freemie inserts may be required to achieve the tunnel size necessary, but they have to be cut down in length to about 20 mm to allow clearance around the pump’s air holes to maintain suction. There are hacks that can allow the Elvie to be utilized for those with more elastic nipples, but it is by far the trickiest pump to size for elastic tissue. I highly recommend booking a professional consultation if you are dealing with elastic nipples with the Elvie pump, as many of the hacks require careful consideration of the nipple tissue and shape to prevent damage to the nipples. For more information about the Elvie Pump OG, click here. For the Elvie Stride Pump, click here.
Elastic Nipples with the Willow Pump
If you are struggling with the Willow Pump and elastic nipples I recommend checking out the Willow Pump page on my website dedicated to getting a good fit with this pump, and the Elastic Nipples with the Willow Pump blog for more information. The constant suction of this pump poses some unique challenges for getting a good fit, and inserts are not a one size fits all solution. This page details all of your options by nipple size so that you can find the freedom this pump allows for yourself!
Happy Pumping! If you are struggling with anything related to breastfeeding or pumping please reach out, or take our Crash Course in Pumping - an online video course designed to answer all of your pumping questions.
Good lactation care and proper education makes a world of difference in your outcomes!
