Absolutely love these. I pump exclusively and the "standard" shields that came with my pump were too big for me. I figured this out after speaking to a lactation consultant about how sore and tender my nipples were during pumping. I went from pumping every 3 hours to now every 4.5 hours, so I pump a lot, and I have to say how grateful I am that Nenesupply makes shields smaller than 21 mm. The 19 mm are the perfect size for me, and have made pumping so much easier and quicker. In addition, the shields also come with the flanges and membranes. A really great deal for all those parts considering how much Medela charges for these parts separately!
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