Flange Sizing- What Does the Data Say?
Originally Posted March 2021. Updated June 2021.
The best practices in lactation are the practices we can support with data. Unfortunately, when it comes to flange sizing, we don’t really have large scale data from randomized trials, so we are pulling on the data gathered from lactation consultants in their practices as to what works and what doesn’t. The limitations of this are that individual lactation consultants don’t tend to see extremely high volumes of clients to generate the kind of data we need to inform practices, and when it comes to flange sizing, very few are carefully tracking this data.
In my own practice, I do flange sizings many times a day and have the added bonus of specializing in the Willow Pump, so I am sizing clients for their standard breast pumps and their Willow Pumps. I was fortunate to be able to track some of this data this past fall to back up what I was seeing and recommending to allow for the start of a data set on flange sizing.
Are there limitations to this data? Absolutely!
Not all clients follow up after being sized, so 100% follow up isn’t something I can currently achieve.
I did not track demographic data for these clients, so I can’t say with any empirical certainty that this data can be applied on a wide scale, but I do know my clientele has been very diverse, and I am not seeing any trends in who needs what sizes of flanges.
This data is only representative of individuals who sought professional assistance in finding their flange fit in my practice during this limited time frame.
This is data exclusively gathered from virtual sizings.
This data only covers 150 clients which is a very small sample. It’s a starting point, but by no means so large as to be 100% conclusive and undeniable.
This data only tracked clients who were being sized based on pain free, undamaged nipple tissue who were either not previously pumping or experiencing any substantial issues with pumping.
This data did not track exclusive pumpers versus occasional pumpers, and we don’t know if this influences anything.
So is this data useless? Nope!
This data is actually super helpful because it shows that I am on the right path with the recommendations I have been making. What I am seeing working on a small scale with individual clients is being backed on a larger scale when assessing the data.
So what did this data show us?
Standard Pumps:
Standard pumps are pumps that use a pull and release suction pattern, and essentially, all available pumps on the market fall into this category expect for the Willow Pump and the Limerick Pumps. These pumps work best when clients add between 2-4 mm to their pre-pump nipple size, with 88% of clients finding success within this range. Given that 62% overall find success at exactly 2 mm added to the base nipple size, we can safely say recommending the 2-4 mm range and having the client start at the 2 mm range means most clients will be good to go with that sizing, and less than half will have to keep trialing new sizes. The data also shows me that only 1% of clients required 4 mm or more of additional room, even when they had been sized much larger than that by other lactation professionals.
This initial data set included 150 sizing assessments and supported the smaller sizing that foes against the traditionally taught sizing methods. Starting at 4+ mm for flange sizing is placing the majority of clients in poorly sized flanges.
This updated data set included an additional 700 clients sizing assessments and showed the trend supports the smaller sizing resulting in comfortable and effective pumping practices. Starting at 2 mm will result in comfortable pumping for the majority of clients, with some requiring small adjustments smaller or larger to achieve the desired fit.
Willow Pump:
The data for the Willow Pump was actually far more valuable and backed up the issues I see with Willow Pump Sizing challenges. When it comes to the Willow Pump, we have a split in clients needing exact sizing to 2 mm added to their base nipple size to achieve this comfortable pumping. The most common sizing needed was exact sizing at 42%, with adding 1 mm to base sizing following at 33%. Only 21% needed 2 mm added to their nipple size (in contrast to the 62% who needed this sizing for the standard pump. A tiny 4% needed 3 or more, and in my practice almost exclusively, the 3 mm or more sizing was reserved for client with inverted nipples that did not easily evert with stimulation and therefore needed extra room to allow the nipple to evert safely.
This confirms that Willow Pump Sizing does not adhere to standard sizing practices and that even when looking at the same 150 clients, the majority needed separate Willow and Standard Pump sizings to be able to comfortably and effectively use each type of pump.
This updated data set included an additional 700 clients sizing assessments and showed the trend supports the smaller sizing resulting in comfortable and effective pumping practices. Starting at 0-1 mm will result in comfortable pumping for the majority of clients, with some requiring small adjustments larger to achieve the desired fit.
What is the Average Nipple Size?
Average nipple size was assessed by taking the largest nipple measurement (height, width, left and right) for each individual. Many pumping groups on social media mistakingly assume that it is uncommon for people to need larger than a 21, but the data is showing that while the majority of people are in need of smaller than a 24 mm flange, it’s not uncommon to need to a 24 mm or larger.
This is why every individual needs to measure their nipples and make sure they are using the right flange size for their individual size! Nipples come in all shapes and sizes, and they all deserve that perfect fit.
So how do I use this data when recommending the sizes that work best for you?
I always recommend a range of sizes when we have multiple options within your target range. If we really only have one size available in your particular range, I am only going to give you that one, but if I have options, I let you know.
I recommend starting in the ranges for Standard Pumps that cover 88% (2-4 mm from prepump sizing) of people successfully, and then we can troubleshoot as necessary.
I recommend starting in the ranges for Willow that cover 75% of people (0-1 mm from prepump sizing) successfully, and look at larger recommendations for flat and inverted nipples that do not evert as easily.
I use this data to guide which direction to look if we are having trouble finding a good fit 100% of the time.
How will this data change in the future?
With each new client I get the opportunity to learn how a different set of nipples respond to flange sizings and to further track data! I am still in the early years of my practice and my data tracking techniques are still being refined. I’m still learning how to harness the analysis capabilities of the Electronic Health Records systems to do more than just keep your data safe and HIPAA compliant. As I track more, and my data sets grow, my recommendations may be refined and changed. The only place to go from here is to keep getting better and until every nipple is able to pump comfortably. There is a need to keep tracking and analyzing!
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