I use a Pump in Style, pump 3 times during my 9+ hour shift, and usually once at home after the babe goes to bed. I do compressions while pumping and massage as well.
As for the horns, I use the 24mm on the left and the 21mm on the right...I think they are the right size after much trial and error.
My problem specifically is that I can't get a let-down without pumping for a LONG time (45+minutes) at which point it hurts. Once I get going, it's great....but I can't realistically take 3 hours out of every workday to pump. I have the best intentions here, but in all practicality, it's not happening. More often than not, I wind up not emptying the breast, and have had been engorged at some point just about every workday.
I have tried videos and photos of the babe as well. Like I said before, this last pumping fail was while I was in my baby's presence (he was sleeping for a long time) and while I was relaxed at home. 1/2 an oz in 45 minutes and I gave up.
I just ordered a manual pump so that I can pump at home "on the fly" hoping that it will help keep supply up...
Sorry to go on and on...I'm so frustrated!!