I Am a 45-year-old MD. I Had Breast Reduction Surgery 22 Days Ago.

At post-op day 10, I had a hematoma on left. PS tried to drain 4 days later and drained for 1.5 days. I had many purple bruises on that breast. But today had new 1 inch redness inferiorly where the drain needle was. It’s ichy/painful. Also today I developed a small dehiscence where areola meets the vertical suture. Is the new inferior redness and open wound are related; sign of infection or developing new wound? Or new hematoma? How many days post-op hematoma can develop? Thanks.

Doctor Answers (7)

Breast Reduction - Drainage at 22 Days Post-Op

+1

Hi nucMD,

You should, of course, remain in contact with your own plastic surgeon throughout this entire process.  There is a limit to what can be determined without being able to examine you or, at the least, without a photo.

In general, though, hematomas are the result of post-operative bleeding that occurs in the first few hours or days after surgery.  They can occur late (hematomas many years after breast implants surgery are well-known, but that's a very different process from what you have) but are most common within the first few days.  It may take a while for the evidence of that bleeding to become apparent, but it's usually a process that starts relatively early.

As blood collects, it will typically clot (depending on how much blood and at what rate it's collecting).  Then, starting at about 7-10 days later, it will liquefy and, at that point, it can be evacuated more easily (than trying at 2-3 days).  Early on, a more formal evacuation of hematoma procedure (under anesthesia) may be indicated, even if later on the liquefied blood can be drained out.

So the fact that you're seeing something new at this time does not necessarily mean you're still bleeding.  I'm assuming that you're in generally good health, have no medical problems, bleeding problems, etc.

Finally, when blood stays inside the body too long it can become infected (an infected hematoma).  At this point, it is somewhat more urgent that it be drained (and the cavity irrigated) if it does not come out either on its own, or with a relatively small procedure.  Antibiotics may be helpful but are not enough if there is fluid that needs to be evacuated.

Exactly where you are in all of this is hard to say, but that is the general guideline I would use in handling a situation such as this.

I hope that this helps, and good luck,

Dr. E


New York Plastic Surgeon
5.0 out of 5 stars 148 reviews

Breast reduction

+1

Consider your operating Surgeon as much a specialist in his field as you are in your field. Small openings, red scars, swelling and ecchymosis are not uncommon after breast reduction.  The Surgeon  will be able to examine you and put your mind at ease. Should there be some postoperative intervention necessary he can find the appropriate procedure and timing.

Please talk to him/her, follow the advice and let him/her guide you in the postoperative management.

"Nature is good" and your chances are good  you will be very happy with your breast reduction result very soon

 

Guido P. Gutter MD
Evansville Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast Reduction Complications.

+1

It is impossible to tell what is going on without getting an examination.  You should return to your sugeon and get evaluated.  

In general, hematomas are most common soon after surgery.  Typically, if they are drained (and no new bleeding occurs), the site typically has more swelling and bruising than would be expected but heals essentially normally.  

Stephen J Ronan, MD
San Francisco Plastic Surgeon
3.0 out of 5 stars 1 review

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You should follow very closely with your surgeon to be properly treated. A hematoma can develop most commonly during the first two weeks after surgery and often requires an open procedure to remove the old clot.

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Late breast reduction hematomas might be caused by elevation of your blood pressure, stretching of the local tissue causing a tear, or trauma to the site.  Sometimes the blood cannot be drained without surgery.  You might be developing a localized infection near your drain and you should have it evaluated by your surgeon.

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It is possible to have a hematoma up to 2 weeks after any surgery and having one at 10 days means that somehow you probably got your blood pressure up and heart rate up such that a sealed off vessel broke loose and bled.  I have seen this from exercising, sex, and just plain stress in patients who were told to keep the HR/BP normal for all of 2 weeks but didn't comply.

Without examinig you it would have usually been the case that if the hematoma were significant, an immediate re-exploration and drainage would have been my choice in these rare circumstances.  What you have now may be the sequelae of the hematoma or may represent infection.  Only being examined by your surgeon can answer this.

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It is rare for a hematoma to develop more than 10 days postoperatively. Without an examination it ismipossiblento determine what might be an infectio. You should see you plastic surgeon and have the area evaluated

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.