Shalom All, 
The thread about leaking and more specifically breast shell induced leaking increasing milk supply has shaken me out of my quiet lurking.  For the past several years I have worked in two post partum mother - baby rest homes, where breast shells are the height of fasion, not the rubberbacked, large opening, lots of airholes type but the all plastic, small opening, no air type.  The main reason women use them is to increase leaking inorder to avoid engorgement.  They swear by them.  There is an every 3 hour nursing schedule at the homes though women can nurse whenever they want.  Most however will try to stick to the schedule - if not try to stretch it longer and find that their breasts remain comfortable wearing the shells constantly between feeds.  I discourage shell use because of the constant pressure on the ducts perhaps causing plugged ducts and the moist warm atmosphere in the shell encouraging thrush.  
    My understanding was that the pressure of the shell on the areola causes the milk that is in that area of the breast to leak but the milk deeper in the breast does not.  The shell itself will not cause a MER.  Right, if a woman is using a breastshell to collect milk on one breast while nursing on the other breast, it is the baby nursing that is causing the MER that is causing the unused breast to leak and fill up the shell.  If the shell is inplace in between feeds, the pressure on the areola, perhaps negative pressure in the shell, causes just the foremilk to leak.  That is why these women can remove their milk filled shells and go on to nurse their babies on full breasts.  Therefore despite the milk leaked into the shell, the breast is still too full of milk to make more milk and will not cause an increase in milk supply.  Or is it, as has been suggested by some of these posts, that the constant leaking is triggering milk synthesis and that the breast isn't remainig full despite the leaking but refilling.  Is there any research on breastshell use?  Does anyone else have extensive experience with them.  Though obviously I strongly encourage mothers to breastfeed frequently and thoroughly to avoid engorgement (as well as all the other benefits) I will feel less bad about their prefered method if I knew that it at least is protecting maybe even building  their milk supplies.

Thanks a lot,
Chayn Fogelman IBCLC, Israel
    

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