I had an NICU mom come to the office with c/o reddened area, sore to touch at about11o'clock directly above the areola. I applied warmth, ( no ice available at that time or would have tried it also), massaged, hand expressed, and used the electric pump. No milk would come out of the pores in that area. After all of the above for 35 min it was sl softer and a drop would appear but not drip out of a pore in the area. I finally thought of the insert that adapts to smaller nipples. We put that in the electric pump and almost immediately milk started squirting out! Within 3 minutes the mom was soft and completely relieved. She thought I was a miracle worker! I think just lucky to finally get it to work. Evonne