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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 for this post. I’m wondering if you can offer any insight into my situation. My daughter is in the NICU still – born at 29 weeks. So I’ve been exclusively pumping since her arrival. But I’m not expressing enough to avoid any supplementation at this point. I asked lactation about the flange sizes early on because I wasn’t getting much milk and thought too much aereola was being pulled in. That sounded like the size was too big to me – but she told me I needed bigger. So with the bigger, I got more milk out, but I never feel drained (and I’ve already had mastitis). I measure 17 mm and am using a 33 mm on the Ameda Platinum. A lot is pulled in and everything starts going sideways as I increase suction. So the nipple rubs a bit with each pull, but only on one side because I’m going diagonal. Any thoughts?
17 mm is your nipple diameter but you use 33 mm? That sounds too big.
I suppose you have tried the standard 25 mm of Ameda and not getting enough milk.
Have you tried going one size down (21 mm) or perhaps use 21 mm insert?
If you read my story, I ended up using 21 mm insert in 24 mm flange (21 mm is my actual size, but when i tried only 21 mm flange, the funnel is too short hence painful and thus I use 24 mm).
Also, a lot of moms have great result using pumpin pals, so you may try if pumpin pals suits you better (the package has three sizes so you can try each of them and see which size fits you better).
Aside from breast shield sizing, I suggest you to do hands-on pumping, i.e. massage your breast while pumping, finish up with hand-expression / hand-pumping, also try if you can get the second let-down. I know, this means more work for you, but I highly recommend to try these methods as it will definitely help you to thoroughly empty your breast and therefore, prevent mastitis.
I don’t know if you’ve read this article:https://livingwithlowmilksupply.com/how-to-pump-more-breast-milk, but basically it gives you more explanation about what I mentioned about hands-on pumping.
Btw, the lactation consultant you saw, is she an IBCLC? IBCLC has a lot more experience (1000+ hours of helping moms in breastfeeding and all) and thus, can give you better suggestions.
All the best,
Rina
Hien Tasays
Hi Rina,
My nipple diameter is 17mm so should i buy Pumpin pad set large or set small?
Thanks a lot,
Hien
To be honest, I don’t know. Perhaps *okay, this is just perhaps* you can try the largest, because we want to avoid the nipple rubbing with the flange’s side wall, right. Does this make sense?
Measuring your nipple is just the first step. You still need to try the ‘new flange’ based on your measurement and see if your pumping becomes more comfortable.
Hope this helps.
Rina
Ivysays
currently using spectra 9+ and is a working mum. i using the maymom measurement and it supposed to be 19mm.. but i get 21mm instead. when i pump, it is more comfortable but.. seems the milk always gather at the breastshield area and i cant get it clear well.
so i used back the spectra standard 28mm.. and it can express more milk.. however, because it can move freely inside.. lesser chance for the milk gather at the breastshield area . normally i will pump 30 mins at work and hand express afterwards. but it seems after 20 mins, then my nipple getting longer and will hit the wall.
once completed the 30mins session, normally i will hand express for a short while… sometimes i can feel some small lumps near the nipple area and hand express can clear it much better. should i continue to pump after hand express? and one of mine is inverted.. it is really hard to hand express and is the one always hit the wall…
how to clear it better and pump more efficiently. need your advice. thanks!
My suggestion is to choose which one you feel more comfortable and more convenient. Does it concern you when it hits the wall? Any pain/ discomfort, etc? Because for me personally, even though there’s no pain, I felt that my breast was not emptied fully when that happened, so that’s why I choose to use other breast shield size.
Also, try to massage your breast while pumping, it will clear out milk faster.
Regarding your question, should you continue to pump after hand-express? That depends. Have you tried second let-down? This is how I do mine: get first let-down, double pump until flow slows down or no milk come out, hand-pumping (to replace hand expression), then second let-down, double pump, hand-pump, and so on. For me, getting 3 let-downs is optimal, but I know for every woman is different. You need to experiment here, there’s no universal rule for all.
Also, have you tried the breast shield insert? it’s a little ‘cone’ that you can put inside the bigger breast shield size, so that your nipple can move further, but you can still restrict your areola from being pulled too much.
nishasays
hi rina,
i am a new mum to a two month old girl. i was those preggies that took it for granted my milk will overflow once the baby is out, sadly aft a stressful emergency c-sec the milk only came about the third day and very minimal.
so i sent my husband out on a quest for a breast pump during my confinement period and he got me a bumble bee breastpump
in the beginning it was fine as i was having my girl direct latch more often. (we are supplementing her w FM btwy), BUT now she pushes the bottle away, prefers the breast!!
so i started pumping more, but the nipple and aerola hurt so bad after the sessions! after reading your blog, i realised my flange size was too big for me!
i t is 24mm with the silicone inserted. i would like to get myself a spectra S1 to do some serious pumping for my girl. can a 21mm shield insert from medela be used for spectra? and where did you find your shield insert in malaysia?
If you mean 21-mm insert inside Spectra 28-mm shield, no it won’t work. Theoretically it can still be inserted, but since the insert is smaller than 28-mm ‘tunnel’, the insert will move as the suction cycles.
So, you need a 24-mm breast shield. I haven’t tried with Spectra 24-mm shield since I already have 24-mm medela, I just used that one.
I’m not sure where you can get the insert in Malaysia, but I know several malaysian mums ordered from Kulily.com and bingbling (both singapore-based) collectively. I got mine from bingbling since it eas near my office.
hope this helps.
jensays
Hello! Thank you for sharing good articles!
It is my second baby so I am reading to refresh myself on how to pump.
Can you recommend any breastshield for Avent pump?
Also, what is the average milk output for the first let down?
.
Jess says
Thank you for this post. I’m wondering if you can offer any insight into my situation. My daughter is in the NICU still – born at 29 weeks. So I’ve been exclusively pumping since her arrival. But I’m not expressing enough to avoid any supplementation at this point. I asked lactation about the flange sizes early on because I wasn’t getting much milk and thought too much aereola was being pulled in. That sounded like the size was too big to me – but she told me I needed bigger. So with the bigger, I got more milk out, but I never feel drained (and I’ve already had mastitis). I measure 17 mm and am using a 33 mm on the Ameda Platinum. A lot is pulled in and everything starts going sideways as I increase suction. So the nipple rubs a bit with each pull, but only on one side because I’m going diagonal. Any thoughts?
Rina says
Hi,
17 mm is your nipple diameter but you use 33 mm? That sounds too big.
I suppose you have tried the standard 25 mm of Ameda and not getting enough milk.
Have you tried going one size down (21 mm) or perhaps use 21 mm insert?
If you read my story, I ended up using 21 mm insert in 24 mm flange (21 mm is my actual size, but when i tried only 21 mm flange, the funnel is too short hence painful and thus I use 24 mm).
Also, a lot of moms have great result using pumpin pals, so you may try if pumpin pals suits you better (the package has three sizes so you can try each of them and see which size fits you better).
Aside from breast shield sizing, I suggest you to do hands-on pumping, i.e. massage your breast while pumping, finish up with hand-expression / hand-pumping, also try if you can get the second let-down. I know, this means more work for you, but I highly recommend to try these methods as it will definitely help you to thoroughly empty your breast and therefore, prevent mastitis.
I don’t know if you’ve read this article:https://livingwithlowmilksupply.com/how-to-pump-more-breast-milk, but basically it gives you more explanation about what I mentioned about hands-on pumping.
Btw, the lactation consultant you saw, is she an IBCLC? IBCLC has a lot more experience (1000+ hours of helping moms in breastfeeding and all) and thus, can give you better suggestions.
All the best,
Rina
Hien Ta says
Hi Rina,
My nipple diameter is 17mm so should i buy Pumpin pad set large or set small?
Thanks a lot,
Hien
Rina says
Hi Hien, small set.
TS says
Thank you for the sharing. My nipple is not round. It’s abit like ovul. So how should I measure? Should I take the largest diameter or smallest?
Rina says
Hi,
To be honest, I don’t know. Perhaps *okay, this is just perhaps* you can try the largest, because we want to avoid the nipple rubbing with the flange’s side wall, right. Does this make sense?
Measuring your nipple is just the first step. You still need to try the ‘new flange’ based on your measurement and see if your pumping becomes more comfortable.
Hope this helps.
Rina
Ivy says
currently using spectra 9+ and is a working mum. i using the maymom measurement and it supposed to be 19mm.. but i get 21mm instead. when i pump, it is more comfortable but.. seems the milk always gather at the breastshield area and i cant get it clear well.
so i used back the spectra standard 28mm.. and it can express more milk.. however, because it can move freely inside.. lesser chance for the milk gather at the breastshield area . normally i will pump 30 mins at work and hand express afterwards. but it seems after 20 mins, then my nipple getting longer and will hit the wall.
once completed the 30mins session, normally i will hand express for a short while… sometimes i can feel some small lumps near the nipple area and hand express can clear it much better. should i continue to pump after hand express? and one of mine is inverted.. it is really hard to hand express and is the one always hit the wall…
how to clear it better and pump more efficiently. need your advice. thanks!
Rina says
Hi Ivy,
My suggestion is to choose which one you feel more comfortable and more convenient. Does it concern you when it hits the wall? Any pain/ discomfort, etc? Because for me personally, even though there’s no pain, I felt that my breast was not emptied fully when that happened, so that’s why I choose to use other breast shield size.
Also, try to massage your breast while pumping, it will clear out milk faster.
Regarding your question, should you continue to pump after hand-express? That depends. Have you tried second let-down? This is how I do mine: get first let-down, double pump until flow slows down or no milk come out, hand-pumping (to replace hand expression), then second let-down, double pump, hand-pump, and so on. For me, getting 3 let-downs is optimal, but I know for every woman is different. You need to experiment here, there’s no universal rule for all.
Hope this helps,
rina
Rina says
Also, have you tried the breast shield insert? it’s a little ‘cone’ that you can put inside the bigger breast shield size, so that your nipple can move further, but you can still restrict your areola from being pulled too much.
nisha says
hi rina,
i am a new mum to a two month old girl. i was those preggies that took it for granted my milk will overflow once the baby is out, sadly aft a stressful emergency c-sec the milk only came about the third day and very minimal.
so i sent my husband out on a quest for a breast pump during my confinement period and he got me a bumble bee breastpump
in the beginning it was fine as i was having my girl direct latch more often. (we are supplementing her w FM btwy), BUT now she pushes the bottle away, prefers the breast!!
so i started pumping more, but the nipple and aerola hurt so bad after the sessions! after reading your blog, i realised my flange size was too big for me!
i t is 24mm with the silicone inserted. i would like to get myself a spectra S1 to do some serious pumping for my girl. can a 21mm shield insert from medela be used for spectra? and where did you find your shield insert in malaysia?
thank you
Rina says
If you mean 21-mm insert inside Spectra 28-mm shield, no it won’t work. Theoretically it can still be inserted, but since the insert is smaller than 28-mm ‘tunnel’, the insert will move as the suction cycles.
So, you need a 24-mm breast shield. I haven’t tried with Spectra 24-mm shield since I already have 24-mm medela, I just used that one.
I’m not sure where you can get the insert in Malaysia, but I know several malaysian mums ordered from Kulily.com and bingbling (both singapore-based) collectively. I got mine from bingbling since it eas near my office.
hope this helps.
jen says
Hello! Thank you for sharing good articles!
It is my second baby so I am reading to refresh myself on how to pump.
Can you recommend any breastshield for Avent pump?
Also, what is the average milk output for the first let down?
Thanks!
Rina says
Avent Comfort has fixed-size breast shield, but it has 2 sizes for the breast shield cushion (normal: 25 mm, large: around 28-mm).
I’m not sure if you are refering to the new model (Avent Comfort) or old model (Avent classic).
If you are using Avent Classic, I believe you can put pumpin pals flange there. Not sure with the comfort one.
For average milk output for the first let down, it will be different across moms. There’s no average I think