Is It Normal 1 Week Post-Op To Replace An Implant And Drain Excess Fluid In Same Procedure?

I went today for my 6-day post-op. My left breast appears to be healing fine, however my right breast is still very swollen and hard. My surgeon seemed a little concerned and scheduled to have the implant removed so excess fluid can be drained. If the swelling does not go down, he will be removing the implant in 2 days, draining, then placing it back in during the same procedure. Is this normal? Should I be concerned? Any tips/advice?

Doctor Answers (6)

Postop care

+1

Is it normal to have the breast implant removed immediately after surgery? no. But it sounds like your surgeon is doing the right thing and not waiting to see if the swelling gets worse. Follow his or her instructions. Sounds like you have a good ps.


Miami Beach Plastic Surgeon
5.0 out of 5 stars 83 reviews

Swollen and hard breast 6 days post-op is hematoma and needs surgical drainage!

+1

Your description is very accurate for a hematoma (bleeding in the breast pocket). This can occur any time within the first 3-4 weeks after breast enlargement surgery, though it is uncommon. My partner and I do several hundred breast augmentations per year, so even with a 1% risk of post-op hematoma, we have to take a patient back to the operating room every few months to deal with this issue. It is not an emergency, but the sooner the hematoma is evacuated, the bleeding point identified and controlled (if it hasn't already stopped on its own, which occurs when the hematoma gets large enough to reach sufficient pressure to stop any further bleeding--that's the hard and swollen part you spoke of), the less the likelihood of developing a capsular contracture.

As long as there was no way for the blood to become contaminated with bacteria (for example, via a drain, another reason I believe drains should never be used in breast implant placement), the implant remains sterile, and cleaning out the old partially-clotted blood, rinsing the pocket with antibiotic or antiseptic irrigation, and replacing the implant effectively restores your breast to its normal healing course. There IS a somewhat higher risk of developing a capsular contracture after breast hematoma, but that risk is significantly higher if the blood is left to "absorb on its own," even if the hematoma is a small one. So your surgeon is wise to want to take you back to the operating room to deal with this. Even after draining a hematoma, I would not recommend any drain being placed, as this is one more way your pocket can become colonized with bacteria, further increasing your risk of capsular contracture and eventual re-operation to deal with this.

Sometimes, it can be difficult to determine the difference between "more-than'average" swelling and a small hematoma, but since I operate in my own accredited office surgical facility and do not charge (anything) for evacuation of hematoma, I do not have any hesitation to do what is best for my patient. I know that in a hospital or stand-alone surgicenter there will be additional costs for re-operation, so there is an unfortunately natural tendency to be hesitant to incur those charges when the diagnosis is in question. Rest assured, "swelling" from hematoma does not "go down" over two days.

Trust your surgeon's advice here, and proceed with hematoma evacuation if that is indeed the recommendation. Even if there is additional cost involved, minimizing the (worse and higher) risk of re-operation later to deal with capsular contracture will save you even more cost, heartache, and potential loss of the cosmetic result you and your surgeon were trying for in the first place. Additional things to ask your surgeon about are use of steroids in the breast pocket after hematoma evacuation (controversial, but perhaps helpful in select cases), and adding the leukotriene inhibitor Singulair or Accolate to your post-op medication regimen to possibly decrease the potential for inflammation-induced capsular contracture vias these pathways (also controversial but helpful in about half of cases such as this). Good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 118 reviews

Hematoma

+1

If you have a hematoma around your breast implant, than it should be removed and the pocket washed out and bleeding stopped, and then the  implant could be repalced.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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You may have hematoma

+1

You have hematoma of the right breast and you need to have surgery to remove the blood cloth and place drains. You are at higher risk for capsular contracture.

Kamran Khoobehi, MD
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Excessive swelling after breast implants

+1

Swelling in one breast a week after augmentation is usually due to bleeding called a hematoma and not a fluid collection. The best treatment is evacuation of the blood, and washing the pocket clean. The implant can be replaced immediately. The sooner the problem is recognized and the sooner treated the better as the capsular contracture rate goes up after such a complication.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
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Removing fliud or blood and exchanging implant

+1

From your description, it sounds as if your surgeon is concerned that you have a fluid collection or blood collection.  In these situations, it is possible to drain the fluid or blood and exchange the implant (replace it with a new implant).  As long as there is no infection, this is a reasonable approach.  The presence of fluid or blood , even if drained and the implant exchanged, can increase the chance that you will develop capsular contracture of hardening around the implant. 

Matthew Schulman, MD
New York Plastic Surgeon
5.0 out of 5 stars 162 reviews

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.