The Truth About Breastfeeding

When I suffered substantial nipple damage in the early weeks of breastfeeding, the ‘moist wound healing’ route didn’t prove effective (see nipple solutions 1: doing nothing), so allowing a bit of air to circulate was the obvious alternative option. Walking around topless wasn’t always practical (although I have to admit it happened quite a bit – apologies to my neighbours) so wearing breast shells provided a workable solution. They seemed to help, psychologically at least, but as I used them on both breasts pretty much all the time, I have no idea whether they really had any effect on the healing process, or the pain I experienced when breastfeeding.

Is there any clinical evidence of their effectiveness? The short answer is not really, although that may be partly because there is very little research looking at the use of breast shells in this context. A couple of studies have reported on the effect of shells used in combination with lanolin, but they obviously don’t tell us anything about the utility of shells in keeping nipples dry¹².

There is one small study, conducted some time ago, which evaluated the use of breast shells on their own as a means of alleviating nipple pain³. 20 women who had just started breastfeeding and were experiencing pain were asked to wear a single breast shell whenever they weren’t feeding (the other nipple was kept shell-free, to serve as a control). On the second and fifth days of using the shells the women were asked to rate the level of pain they were experiencing on a 5 point scale, from mild (1) to excruciating (5) during the first two minutes of a feed, and for the period between feeds. Although the mean pain score was higher for the nipple without the shell on day five, this difference was not statistically significant. The study did have an interesting anecdotal result, however. Despite the fact that the shells didn’t lessen pain, 80% of the women said they would consider using them again, so the majority of women felt that they offered some kind of help. The precise nature of the benefit isn’t described in detail, but it appears to be related to improved general comfort and decreased friction with clothing.

Problems mentioned by some women (although it is not reported how many) focused on concerns about the ‘hardness’ of the shell, and the pressure it exerted on breast tissue. The possibility of pressure on milk ducts is also mentioned by shell manufacturers, who advise against using breast shells for extended periods (although they also market the same action as a short term means of relieving engorgement). Whilst the possibility of negative consequences arising from pressure caused by shells can’t be dismissed, there don’t yet appear to have been any reported in the clinical literature, so the extent to which a problem actually exists isn’t clear.

The lack of research in general into either the benefits or drawbacks of breast shells makes it difficult to draw any firm conclusions regarding their use. Whilst problems arising from pressure on breast tissue cannot be dismissed, as yet, these have not been widely reported. There isn’t any data showing they improve nipple pain, although there is anecdotal evidence that they ease discomfort.  You may find they take up too much room in your already overstretched bra, or you might find the way that they stop it rubbing against your nipples provides a little relief. If the latter is the case, breast shells do have one undeniable advantage: they allow you to minimize friction, without having to resort to indecent exposure…

1. Arch Pediatr Adolesc Med. 1998 Nov;152(11):1077-82.
2. J Perinat Educ. 2004 Winter;13(1):29-35.
3. J Nurse Midwifery. 1988 Mar-Apr;33(2):74-7.