I primarily breastfed, so these were used infrequently. The two items in the photo above have been opened but are unused (no boxes). The nipples below have been used: • Size S: Used approximately 5-10 times • Size M: Used approximately 2-3 times Please purchase only if you understand that these are used items. I will carefully sterilize and clean them again before shipping. Feel free to comment if you have any questions.