Flange fitting
Much of these blog posts start as questions from clients. Today I had a client thell me they were sized for flanges by a previous IBCLC in person (I am seeing the client virtually). I asked how the sizing was, did she measure and then try one different sizes? How about different shapes? Did she keep trying until she was getting sprays of milk and it was comfortable? Nope. The client was measured, told she was 17mm but to size up to 19mm.
Let’s start right there. First, sizing up is an old way of doing it and doesn’t really understand breast and nipple stimulation. When I am sizing a client in person, we do start with a measurement. That is only a starting place. It is also important to note that we are measuring the tip of the nipple, not the base. And the nipple must be stimulated first. This can mean just opening the bra up and having cool air, can mean the client puts their hands on, feeds baby, hand expresses or even pumps for 5-10 seconds. When our nipples are stimulated, they shrink! They constrict and get firmer and smaller. So if we measure a soft, warm nipple it will be larger than when someone is pumping.
Then we take that starting measurement, say 14mm, and we try at least 13mm, 14mm, 15mm. If any of those feel great we can stay there and try them out for a week. Many times we need to try lots of sizes to find that right one. Remember the goals are:
Totally comfortable pumping, no pinching or pain
Most amount of milk in the least amount of time
What it looks like to me as the provider doesn’t matter nearly as much as what it feels like to the client. Sometimes we have a good size but it still doesn’t feel just right. That usually means we need to try a different shape in the same size. There are now 5 different shapes! Classis, Comfy, Crater Pano and Saucer. These have different angles and will get in different amounts of breast tissue. So even if you are using a 14mm after sizing and trying some on, if it doesn’t feel great you might just need a different shape!
Then if we want to add in more fun, people who are hypermobile (more common in the neurodivergent population) need speciality sizing and flanges. Rarely do hypermobile clients have great comfort and milk supply with hard plastic flanges!
Flange fitting is a mix of art and science. Yes we have evidence (this study here is great) but flange fitting, like all care, needs to be individualized. What works for one client won’t work for another. So if your IBCLC measured you and said “You are a 17mm, here you go” without any trying different sizes, then you really didn’t have a flange fitting!
Lastly this can be done virtually. It’s easie rin person, mostly so that the client doesn’t need to buy different size flanges to try. However it absolutely can happen virtually (and I do this often). We start the same with measuring and then clients can order kits like this “Goldie Pack”.
If you were “measured” and sent on your way, reach out today for a true flange fitting!