Did you know that breast shields ( flanges) come in different sizes? Many mummy experience inefficient pumping session, and the reason is usually because of wrong breast shield size. Many breast pumps ship with size 27mm or 28mm in Singapore; however, that doesn’t mean that everyone will fit that size (we don’t all wear the same sized shoes, after all). There are breast shields on the market ranging in size from 15mm to 36mm!

Follow this simple guide to determine your breast shield size but first thing first

Pump for 5 minutes, and then measure

It’s a common misunderstanding to measure your nipple before you start pumping, but you actually have to measure the nipple after you pump. The reason is simple. The nipple swells while pumping, and since the rate of swelling varies between women, it’s important to take this swollen measurement to select a comfortable shield size. Grab the shield that came with your pump, assemble it to the milk collection kit and then pump on a low setting for 5 minutes, so the nipple swells. You might even express milk while doing this (if this is your first time pumping, be sure to use the lowest vacuum setting to avoid any pain or discomfort).

Measure the diameter of the nipple at the base of the nipple

After your nipple has swollen, measure the diameter of the nipple at the base of the nipple. Be careful not to include any areola in the measurement. Gently lay a ruler onto the areola next to the base of the nipple so the measurement lines are visible when looking straight at the breast. This can be tricky so some women find that doing it in front of a mirror or using a smart phone in selfie mode is helpful.

Select a shield size 2-3mm larger than your nipple diameter

To allow the nipple to move freely within the flange while pumping and to avoid any pain or discomfort (or worse – blisters!) from rubbing, select a shield size that is 2-3mm larger than the diameter of your nipple. For example, if your nipple measures at 18mm, you would want to try the 20mm shield. It’s important not to go too large either because excess areola can be drawn into the flange, causing discomfort, pain, or even constriction of milk flow.

Signs your breast shield may be too small

• Painful rubbing of nipple in flange.
• Nipple not moving freely inside of flange.
• Redness of the nipple.
• Whiteness of the nipple and/or a white ring around the base of the nipple.
• Little milk is being expressed.
• General discomfort while pumping.

Signs your breast shield may be too large

• Excess areola is drawn into the flange or even up and around the nipple. Note that a small amount of areola may enter the flange for some women; however, it should never be uncomfortable or painful.
• Sensation of pulling and/or pulling pain.
• Nipple is pulled to the end of the flange.
• Shield falls from the breast while pumping.
• Little milk is being expressed.
• General discomfort while pumping.

Size that is just nice

• A properly sized breast shield should be very comfortable.
• You should barely be able to feel it while pumping.
• Just a gentle tugging sensation on the nipple and nowhere else.
• You should not see any excess areola being drawn into the flange
• Should not feel a pulling sensation or pain while using your breast pump.
• After your pumping session, your nipple should be free of any redness or whiteness.
• Pumping should be pain-free

Additional factors impacting breast shield size

Although the above instructions provide a good indication of the size of breast shield you will need, there are few things to consider:

• Every woman’s body responds differently to pumping. It is possible your measurements before pumping might change during pumping, therefore we suggest taking measurements of the swollen nipple 5 minutes after pumping.
• Your measurements might be different throughout the day. For example, you might be fuller in the morning after going a few hours without pumping and/or feeding at night, warranting a larger size. You might also be smaller in the evening after consistent pumping or feeding throughout the day.
• You might be larger at the beginning of a pumping session, and smaller after some milk has been expressed.
• Your measurements might change after your milk supply is well-established (about 10 weeks postpartum).
• One breast may need a different sized breast shield than the other.

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).

• 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.

SLB Nipple Ruler

Simply print it out, fold along the line, and carefully cut out the circles.

The nipple ruler works on both US Letter and A4 paper sizes. Make sure you select “full size” or “100%” in your print menu (don’t “scale to fit”). You can also print it on larger sizes like US Legal or A7, but you might have to trim off the extra

At the end of your pumping session, use the circles to measure the diameter of your nipple at the base. You should select a size that is snug, but not constricting, around your nipple.

Here’s another Nipple Ruler we found from MayMom

If you have more questions or need further help with breast shield sizing, reach out to a Certified Lactation Consultant. In the long run, it’s worth taking the time to determine the breast shield size that’s right for you. You’ll benefit by maximising your pumping sessions so you can get back to what matters most – the little one you’re pumping for!

Reference
https://pumpables.co/measure/
https://spectra-baby.com.au/measuring-nipple-correct-flange-size/
https://www.medelabreastfeedingus.com/article/143/breast-shield-sizing:-how-to-get-the-best-fit