The choice of flange size, and more recently, its shape, has long been presented as a central determinant of pumping comfort and efficiency. Yet, the evidence base underpinning current clinical recommendations remains surprisingly limited.

An entire ecosystem of "breast pumping coaching" (offered by non-professional lactation influencers) is developing, representing a new marketing niche in the breastfeeding field. However, as this review highlights, much of the information in circulation is not evidence-based.

The global breast pump market grew from approximately $620 million in 2011 to over $2 billion in 2024. Wearable pumps (hands-free pumps worn inside the bra) represent a fast-growing segment, estimated at close to $900 million by 2030.