When and how to properly fit a breast pump flange

Many pumps come with generic flanges which are ill-fitted for their individual users. Flange fitting is an important part of ensuring a comfortable pumping experience that maximizes milk output. If breast pump flanges are too small, they can restrict tissue and cause clogged ducts. If they are too large, they may inhibit milk output. Flanges that are too big or too small can cause pain and even nipple damage. A correct flange size makes pumping comfortable and efficient. 

The best time to check for a proper flange fit is postpartum. Breasts and nipples can change during pregnancy when we have increased levels of estrogen, progesterone, and prolactin, and again after pregnancy when estrogen and progesterone levels drop rapidly, and prolactin and oxytocin levels dramatically rise. Lactation itself creates a denser tissue in the breasts, and the fatty and connective tissues of the breast shift during this time. Nipple and areolar tissue change postpartum, as well, with many moms finding more elasticity in this tissue. Pregnant breasts and nipples can be very different from actively lactating breasts and nipples, which is why the best time for nursing/pumping bra sizing and flange sizing is after lactation has stabilized. We recommend waiting at least two weeks postpartum for flange sizing. This allows breastfeeding to be well established and for these hormonal and anatomical changes to take place.

When checking flange size fit, the center of the nipple should be in the shield and then the pump turned on. Watch to ensure nipple tissue is not rubbing on the flange, and minimal areolar tissue is pulled into the pump. If you're unsure of the fit, pump for at least 2-5 minutes, as nipple tissue can change throughout a pumping session. During this time, feel for comfort and observe output.  

If it feels daunting to fit yourself for flanges, our IBCLC team at Des Moines Midwife Collective Lactation Clinic can help. We carry a variety of flange sizes and styles, offering you the opportunity to find what works best for you. Our skilled lactation consultants will guide you through the process, sharing observations, and taking your specific needs into consideration.