I used the standard 24mm size that came with my pump in style for months. I hated pumping, truly hated it. So much so that I contemplated weaning on a regular basis because of how painful and miserable the whole experience was. However, I enjoy breastfeeding, so I didn't really want to stop. After discovering that different flange sizes can make a difference in comfort and production, I searched around and found these. I tried the 19mm, which was infinitely more comfortable than the 24mm. TMI - It doesn't feel like my nipple is being ripped off of my chest anymore. I even pumped without using my Motherlove ointment, and it still didn't hurt. (But I still love the Motherlove.) That being said, I haven't noticed a difference in output yet, and as we all know, if the pumping isn't effective enough, you pay for it later. I get plugged ducts a lot and was hoping the smaller size would fix that, but I can't say there's been a difference. Some people have complained about it being harder to clean, but I disagree. It is in one piece, but its design is slightly different, so as long as you have a bottle brush with the smaller attachment, it's easy to clean, maybe even more so than the regular pieces. Ultimately, I think it's definitely worth a try if you're having problems, especially for the price.
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