Flange Sizing Can Be Complicated
Flange sizing seems like it should be fairly simple right? Measure a nipple, and then, look at a chart somewhere to convert that measurement to a flange size. Nothing complicated here.
I wish it was that simple, I really do.
Most pumping parents do not think about flange sizing until after their baby arrives, and after they have already started using a breast pump. Many start pumping in response to a complicated nursing relationship in which nipple pain and damage has already been suffered.
Many don’t seek professional help from a trained lactation consultant until after they have already tried the wisdom contained in breastfeeding Facebook groups, or tried several flange sizes themselves based on self-diagnosis of the size issues. It is not uncommon for me to have a sizing client who has already tried 5 or more sizes, and spent hundreds of dollars on different flanges.
When I size someone for flanges, I always have them take a photo with the L-Shaped Nipple Ruler™ I designed as the starting point. This measurement is crucial to getting the proper flange sizing, but it isn’t everything unfortunately. Once I have the current size of your nipple, I have to take into consideration all of the following:
Shape of your nipple: is it circular, oval, on a slant, erect and everted, flat, inverted. Is it more like a gumdrop with clear delineation of the nipple and areola, or is it more like a cone where the actual boundary of the nipple is a bit trickier.
The previous sizes and styles you have tried, and how they have felt for you: What worked, what didn’t work, what was painful, and how did the pain present? How long did you use the wrong sizing, and how severe is the resulting damage?
The pump or pumps you are using: Willow Pump and Baby Buddha both have extremely strong suction, and the wrong size there can cause substantial bruising quicker than other pumps, meaning we have to heal the nipples while trying to size in order to have pain be a meaningful guide in the sizing process. Some pumps are weaker pumps, and the fact that you were not getting output is related to the pump, not the flange size.
How damaged are your nipples? If your nipples are torn to shreds, swollen, or actively infected we need to address that before your sizing will be accurate. We can’t heal them with the wrong size flanges in most cases though, so we have to gradually reassess and resize you several times.
How long has this damage and trauma been going on? It’s not uncommon for the trauma to have been sustained after the course of months, it is going to take time to unpack and heal a nipple that has gone through this.
If you have an infection, what type of infection is it? Is the treatment helping or hurting your nipple condition? Are you having a bad reaction to the topical treatment?
Do you have a clogged duct or nipple bleb? These can actually cause swelling underneath the nipple and areola artificially inflating your nipple size.
Then, after all of that, we have to look at how pumping practices impact the breast tissue:
Do you tend to use a high suction or lubrication? Both of those could cause extra stretching of the nipple.
Are you using a standard “funnel to tunnel” flange? Maybe the issue is that hard ring and where it hits your nipple versus a size issue.
Are you pumping without lubrication? Maybe you are sensitive to the friction and that is the issue even with a properly sized flange.
Are you pumping with a high suction pump that may not be allowing your nipples the opportunity to fully heal?
We also have to consider if you are also latching, or were latching at some point, that the damage was not the result of pumping, but is damage that was not properly addressed and is now exacerbated by the pumping. If you are still latching your baby, and there is an issue with the latch, there may be ongoing nipple trauma from latching that needs to be addressed before we will see any improvements in pumping. This is perhaps the most complicated of situations that can arise as the cost to be sized for flanges is between $25-$95, while the cost to see a lactation consultant for latching concerns is typically a minimum of $120. Your health insurance should be covering this cost, but unfortunately, not all insurances do this in an effective manner. So, you may not get the results you want for your sizing fee because the pump and flanges are not the issue, no matter how good the person sizing you is.
All of this to say sometimes sizing is simple and straightforward. I measure your nipples, assess your breast anatomy, and find no potential issues, recommend 2-3 sizes and potential styles for you to try, and off you go to happy pumping with the perfect flange size.
Sometimes, flange sizing is a complicated puzzle of trying to figure out what is going on with a damaged nipple, walk back the damage, and find the proper flange size and style all while simultaneously maintaining your milk production. So, if you are getting frustrated when sizing hasn’t produced the results you were hoping for, understand that it may be a complicated situation, and to please keep letting me know what the different flange sizes are doing for you so we can keep working on getting you where you need to be.
