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This is part 2 of ‘Pumping 101’ series. In the previous article I’ve discuss things you should know even before start pumping. Now let’s move ahead and discuss about how to get correctly-fitted breast shield.
Incorrect breast shield makes pumping uncomfortable(or in some cases, painful). This is especially true if you are using breast shield that is too small.
Not optimal pumping output. With incorrectly size shield, you pump less milk. Yes, this is true. In my experience, getting correctly fitted breast shield may increase the pumping yield up to 20%.
So now, how to make sure you got the correct breast shield? In this article, I share my insights on how to choose properly fitted breast shield and my personal experience that proper fitting does matter a lot. Read further to know more.
This post is part of PUMPING 101 series.You may be interested to check out other articles in this series:
Medela recommends choosing breast shield with inner diameter 4 mm more than your nipple diameter, whereas Maymom mentions 2-3 mm. For these two resources, my guess is to measure your nipple diameter before pumping.
Pumpables, on the other hand, clearly explained that it is best to measure your nipple diameter after pumping for 5 minutes.
Having tried those resources, I personally prefer Pumpables guide because it is pretty straight forward and the nipple ruler is also easy to use. However, if you have not pumped before (say, still pregnant), I guess Medela or Maymom guide will work better for you to get initial estimate. Remember though, once you start breastfeeding or pumping, your nipple will change its diameter (thus the additional few mm added).
Pumpables nipple ruler
However, you should not follow this guideline blindly because the info graphic merely relies on nipple diameter only. In addition to nipple diameter, you should also consider the following factors:
Check how your nipple moves while pumping.
The nipple should move freely and it should not rub the side wall of the flange. You may see a little bit of areola gets pulled, but not the whole areola. And your nipple should not hit the back wall of the breast shield.
Comfort
Even if you think you already choose the best breast shield size, but you feel uncomfortable / painful while pumping, that means something is not right. Try to size up or down. Nipple redness / or sore feeling after pumping is also an alarm that you may need to choose different breast shield size.
Effectiveness of pumping
If you feel you breast is not emptied after pumping, you may suspect that you don’t use the correct breast shield size (note: various factors can affect this, breast shield size is just one of possible reason).
PS: Check out this article for more in-depth explanation for nipple pains while pumping (includes reasons and solution).
Breast tissue / elasticity
Some women has a very elastic tissue so that the skin will get pulled easier. In this case, it is possible that pumping makes nipple get elongated so much until it hits the back wall of the flange. For this case, using breast shield with longer ‘tunnel’, or using smaller insert in bigger breast shield may help. More discussion about this below.
Suction preference matters
The stronger the suction you use during pumping, the more your nipple will be pulled into the tunnel. And there is higher chance to hit the back wall of the tunnel if you have quite elastic tissue. In this case, using ‘insert’ would be best approach to use.
IMPORTANT!
Your left nipple diameter may not be the same with your right nipple diameter, and thus may require different breast shield size.
Your nipple diameter may change (enlarge a little bit) during pumping session.
As you pump regularly, your nipple diameter may change again. So it’s best to reassess your breast shield size every few months.
How I found my correct breast shield size
When I purchased my Medela breast pump, i refer to Medela guidelines to determine my correct breast shield size.
Based on nipple diameter alone, it would be the 21-mm size (size S). So in addition to the standard 24-mm shield (size M), I purchased the 21-mm one.
My mistake:Â
I didn’t compare from the beginning between using the two sizes. I used size S straight away, and use the maximum comfortable suction level I could.
Honestly, back then, I was not impressed by my Medela performance because it didn’t really empty my breast fully. But I thought that’s just how electric breast pump is.
One day, I decided to use the standard flange, and to my surprise, I got more milk. At that time I felt like dumb for not trying it from the very beginning.
I began using size M from that point onward, until I decided to try a new breast pump. Â Again, conversation with seller pointed me to the Medela guide again and I started wondering why this guide didn’t work for me.
My new pump had a flange diameter of 25 mm and I could feel that it was not extracting milk efficiently.
My nipple was constantly hitting the back wall of the flange. Not, it was not painful, but the suction become less efficient.
So I tried experimenting with different flange size, including attaching Medela 21-mm inside the original Spectra flange (yes, seriously I did that). And it works much better, but not so convenient.
So I searched for better option when I stumbled upon ‘breast shield insert‘. Aha, I think this is the one that I need. So bought a pair from my local retailer and totally in love with it.
Here’s how it looks like. It says Medela 21-mm insert (NOT 21-mm breast shield, they are different!)
The advantage of using insert vs breast shield is you get a much longer tunnel length, so nipple won’t easily hit the back wall of the flanges even in highest suction setting.
And you know what? Once I switch to using my new ‘breast shield system’, which essentially using a 21-mm insert inside a standard breast shield, my pumping yield increases up to 20%. Whoaa… I wish I figured this out much earlier..
Lesson learnt: if you are not sure which size work best for you, compare from the beginning, don’t just assume one is better than the other.
So, again, I strongly recommend you to compare several breast shield size right at the beginning, especially if you have not found a good fit with the standard size that comes with the pump.
Now that you’ve heard my story, I wanted to share some of my readers’ story who managed to avoid pain while pumping and have increased their pumping output by using the correctly-fitted breast shield.
Aida has recently shared her success on increasing her pumping output after switching to a smaller breast shield.
Here’s what she said:
It’s really true! Correct flange size will give better output. My first baby is almost 3 months. I have no deep knowledge about breast milk since this is my first baby.
I really dig the info because I wonder how other people can make it, how to breastfeed my baby till 2 years if everytime I pump I feel pain and sore. Then only I know how to measure my nipple and choose the right flange size.
From flange size of 28 mm, I changed to 24 mm, and now 21 mm. It really hurts when I pump using 28mm breast shield because it also pulls quite big range of my alveolar. Now, no more pain. .
(look at the pic) After 20mins pumping, my baby woke up. I direct fed my baby and continued to pump the other side to complete 30mins. Before this most yield is 3 oz each side. Thats the max, normally it is less than that, hahaha.
Rina’s comment:Â Â from 3 oz each side to 3.5 – 4.8 oz, wow.. that’s a huge increase, congrats, Aida.
Another reader, Linda, shared that after using the 21-mm insert, she managed to increase her pumping output.
I just bought “Medela breast shield 21-mm insert.” It fits Spectra 24-mm flange too, or if you use Medela, fits in 24-mm flange. I’m using both. I also used hospital grade Spectra breast pump (i.e Spectra S1). Guess what? My output is 150% up (compared to my yield when I pumped for my first born)!
So, if you haven’t tried to really measure your correct breast shield diameter, you should do this. Correctly-fit breast shield leads to more milk, proven!
Let’s talk about tissue elasticity now.
When your breast tissue has higher elasticity, the tip of your nipple may extend all the way towards the end of the tunnel, no matter which size you use. In addition to choosing breast shield with longer tunnel or using insert, you may also choose soft silicone flange instead of hard-plastic flange. The silicone flange may help giving more grip to hold your areola so that it won’t extend too much.
Suction preference (higher suction: the nipple may swell more or you may need longer breast shield tunnel)
Breast tissue elasticity (more elastic: longer breast shield tunnel or need to opt for silicon flanges / insert)
Effectiveness of pumping (more milk with correct breast shield size)
If you feel that your breast pump brand does not cover a wide-variety of breast shield sizes, here are some recommended accessories that may help:
Maymom breast shield: covering breast shield diameter from 15-36 mm (plus 22-mm and 28-mm inserts), also those compatible with Spectra
Pumpin Pals super shield: 3-size angled breast shield that promotes pain-free pumping and no need to leaning forward while pumping.
Inserts for those needing smaller diameter but longer tunnel: Maymom has produced both hard and soft silicon inserts of various sizes (the soft ones can be used for hands-free collection cup and wearable breast pump such as Elvie and Willow, too) .
I hope this article will help you to pick the correct breast shield size, and thus, able to pump more effectively.
Still need help in deciding your perfect breast shield size? You may check out:
Pumpable fitting room ( FREE consultation with Pumpables team, send your pumping video over and let them share their suggestion)
Online consultation with lactation consultants (a short video consultation for a small fee, such as this).
Now, my question to you: Have you tried various size of breast shields and picked the correct one for you? How was it? Do you think using correct breast shield can maximise your pumping output? Share your insights with us!
Thank you so much for this article. I am distressed as I can’t figure out the correct flange size for myself. I use the Spectra S1 with a Spectra 28mm flange. My nipple rubs against the sides while pumping which would suggest that flange is too small. But at the same time my nipple hits the back wall of the flange and a lot of my areola is drawn into the flange – this would suggest the flange is too big? I have tried the larger 32mm Spectra flange but the problem of hitting the back wall of the flange remains. What would you suggest in my case? You mentioned using flanges with longer tunnels or inserts- which brands have longer tunnels and which brands have inserts? Many thanks in advance!
Hi JL,
Have you tried measuring your nipple diameter? How much is it?
Hm.. I am a bit confused with your explanation.
If your nipple is rubbing against the side wall, there’s no way your areola will be drawn into the flange. Is it maybe your areola which rubs against the side wall?
Since you mentioned your areola is drawn a lot inside the 28-mm flange (and nipple hitting the back wall), it seems to me that the 28-mm flange is too big for you.
I suggest you try the smaller size (25-mm flange), and see if your areola is still drawn a lot inside and your nipple still hits the back wall.
You asked which brand has longer tunnel diameter and insert => It’s Maymom.
The 30-mm flange especially has much longer tunnel compared to other brand.
It has 22-mm insert (to be used in 25-mm flange) and 28-mm insert (to be used in 30-mm flange).
If you decide to try Maymom brand, you can use a simple hack to connect it to your Spectra pump (search: “spectra hack “in my blog’s search bar).
Let me know if you manage to solve your problem, and feel free to contact me again if you have further question.
Cheers,
Rina
Teesays
I am having the exact same problem. Nipple rubbing against the side and hitting the back wall. Plus the spectra empties my left breast but not my right. When I go down in size the friction against my nipples is too painful. I am about to give up!
Hi Tee,
If your nipple is rubbing against the side, that’s definitely too small.
Have you tried going one size up? Or use PumpinPal?
Also, if you have trouble emptying your breast, I’d strongly recommend massage while pumping and follow up your regular pumping with hand-expression / manual pumping. This is the only way I can empty my breast thoroughly.
I think that you have a wonderful site and so much information but it took me a lot of searching to find how to leave a comment but glad that I was able to find it
I think you will do even better in your second year
Thank you for taking your time to visit my website and leave a comment.
I really appreciate it.
Thanks for your compliment and I continue trying to write better articles to serve my readers.
All the best for you, too
JL says
Thank you so much for this article. I am distressed as I can’t figure out the correct flange size for myself. I use the Spectra S1 with a Spectra 28mm flange. My nipple rubs against the sides while pumping which would suggest that flange is too small. But at the same time my nipple hits the back wall of the flange and a lot of my areola is drawn into the flange – this would suggest the flange is too big? I have tried the larger 32mm Spectra flange but the problem of hitting the back wall of the flange remains. What would you suggest in my case? You mentioned using flanges with longer tunnels or inserts- which brands have longer tunnels and which brands have inserts? Many thanks in advance!
rina says
Hi JL,
Have you tried measuring your nipple diameter? How much is it?
Hm.. I am a bit confused with your explanation.
If your nipple is rubbing against the side wall, there’s no way your areola will be drawn into the flange. Is it maybe your areola which rubs against the side wall?
Since you mentioned your areola is drawn a lot inside the 28-mm flange (and nipple hitting the back wall), it seems to me that the 28-mm flange is too big for you.
I suggest you try the smaller size (25-mm flange), and see if your areola is still drawn a lot inside and your nipple still hits the back wall.
You asked which brand has longer tunnel diameter and insert => It’s Maymom.
The 30-mm flange especially has much longer tunnel compared to other brand.
It has 22-mm insert (to be used in 25-mm flange) and 28-mm insert (to be used in 30-mm flange).
If you decide to try Maymom brand, you can use a simple hack to connect it to your Spectra pump (search: “spectra hack “in my blog’s search bar).
Let me know if you manage to solve your problem, and feel free to contact me again if you have further question.
Cheers,
Rina
Tee says
I am having the exact same problem. Nipple rubbing against the side and hitting the back wall. Plus the spectra empties my left breast but not my right. When I go down in size the friction against my nipples is too painful. I am about to give up!
Rina says
Hi Tee,
If your nipple is rubbing against the side, that’s definitely too small.
Have you tried going one size up? Or use PumpinPal?
Also, if you have trouble emptying your breast, I’d strongly recommend massage while pumping and follow up your regular pumping with hand-expression / manual pumping. This is the only way I can empty my breast thoroughly.
paul goodwin says
Hello
I think that you have a wonderful site and so much information but it took me a lot of searching to find how to leave a comment but glad that I was able to find it
I think you will do even better in your second year
best regards
paul
Rina says
Hey Paul,
Thank you for taking your time to visit my website and leave a comment.
I really appreciate it.
Thanks for your compliment and I continue trying to write better articles to serve my readers.
All the best for you, too
Rina