This is a Medela manual breast pump. I haven't used it much, as I've mostly used electric ones. The included 24mm breast shield is unused. The bottle may show some signs of use. Also, for those who want it, I'll include the Maymom breast shield flanges shown in the second photo. I have 17mm and 16mm sizes. If the breast shield size doesn't fit properly, you can't pump effectively, so it was essential for me (that's why the M size 24mm that came with the pump was unused). Maymom flanges cost almost 2000 yen for a set of two, but if you're unsure if the size is right, or just want to try them out, please let me know.