Choosing the right size PersonalFit™ Breastshield If you are using a breastpump to remove milk for your baby, it is very important that you have correctly-fitted breastshields. The breastshield is the part of the pump kit that fits directly over your nipple and forms a seal around the areola (the darkened part of your breast). The breastpump works by creating a vacuum, which gently draws your nipple into the tunnel of the breastshield – just like your baby would draw it into the mouth with sucking. A correctly-fitted breastshield will make your pumping comfortable and allow the pump to remove as much of your milk as possible each time you pump. Medela PersonalFit™ breastshields are available in five sizes: Medium (24mm), which is the size that comes with Medela’s breastpump kits; Small (21 mm), Large (27 mm), Extra Large (30 mm), and XX Large (36mm). Medela’s breastpump kits make it easy to use a larger or smaller breastshield, because all sizes are designed to fit into the same connector on the kit. Many women appear to benefit from a size other than the standard 24 mm breastshield. It is almost impossible to tell which size breastshield is the best fit without watching the nipple movement during pumping. The following tips will help you determine whether a different size breastshield would be right for you. Remember the word ‘COMFY’ to determine whether you might need a different size breastshield. The term was designed to help you remember five specific guidelines about breastshield sizing. The following identifies these five guidelines: ‘COMFY’ C – Centered nipple which moves freely. Look at your nipple as it is drawn into the tunnel of the shield during pumping. It should move freely and easily and should not rub against the sides of the tunnel. If the breastshield fits tightly, your nipple will rub against the sides of the tunnel with each vacuum movement of the pump. O – Only a little or no areola tissue is pulled into the tunnel. When your nipple moves freely in the tunnel of the breastshield, you will also notice a gentle pulling movement in the areola each time the pump cycles. If you do not see any movement in the areola with the pump vacuum, the breastshield is probably too small. If you see a lot of movement of your breast or a large amount of areola tissue is pulled into the tunnel, the breastshield is probably too big. M – Motion of the breast is gentle and rhythmic with each cycle of the pump. Just as you should see gentle nipple movement each time the pump cycles, you should also see gentle breast movement. This breast movement suggests that the breast is getting proper stimulation while pumping. F – Feels comfortable pumping. Pumping should be comfortable for you and should not cause nipple pain or tenderness. If you feel any pain or tenderness, your breastshield is probably too small. Y – Yields a well-drained breast.Your breasts should feel soft after each pumping session. An incorrectly-fitting breastshield can affect how your breasts empty and lead to problems with milk supply. During pumping, your milk flows out of the breast due to the pump’s vacuum and your milk ejection (or “let-down”) reflex. However, an incorrectly-fitting breastshield does not allow good breast emptying-even with the best breastpump and a strong milk ejection reflex-because it squeezes the small ducts inside the nipple that carry your milk out of the breast. Ordinarily, these ducts increase in size when you feel milk ejections so that the milk can flow out of the breasts quickly and easily. However, if the ducts are squeezed by a too small breastshield or not emptied by a too large breastshield, some milk stays behind in the breast. Eventually, this incomplete milk removal can lead to plugged ducts, mastitis, and problems with low milk volume. You may note breast engorgement that seems to last a long time – or little ‘knots’ or hardened areas in the breast that do not seem to empty with milk expression. If you experience nipple tenderness around the outside surface of the nipple or problems with breast emptying-your pumping will probably be improved with a different size breastshield. You will want to correct these problems as soon as possible. Sometimes you may experience discomfort at the base of the nipple due to rubbing of your breast tissue with the breastshield tunnel. Use of a lubricant such as Tender Care™ Lanolin may be beneficial. For more information or to purchase Medela’s PersonalFit breastshields, contact your lactation professional.