Hematoma Without Bruising or Pain?

I am 4 1/2 weeks post revision w/implant exchange to silicone. Full capsulectomy on right and pocket revision on left. History of pstosis, opted against lift. Drains for 2 1/2 weeks on right, 3 weeks on left (fluid never completely clear, just reduction in amount to 7.5cc daily) Left breast is still larger than right, doc thinks it may be a hematoma and would like to drain. Can I have a hematoma without pain, bruise or hardness? (In defense of surgeon, breast was harder at last appt.)now softer.

Doctor Answers 10

Breast Hematoma

It is possible to have a hematoma without pain, bruising or hardness. It is difficult to tell what you have just by looking at your photos. Your surgeon has the best vantage point to make decisions concerning your situation and if you trust him then I would suggest that you follow his/her advice. If you are not sure, then a second opinion by a BC plastic surgeon can be helpful. Good luck.

Minneapolis Plastic Surgeon
5.0 out of 5 stars 115 reviews

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The left side has a little more superior fullness.  I would obtain an ultrasound in this situation, since the findings are not "classic" for hematoma.  That test should be helpful to clear up the diagnostic confusion.


All the best,

Breast augmentation revision

You are 4 and a half weeks out, a hematoma without pain is possible and without bruising if you just recently bled is possible as well. But since you are so far out from surgery it is unlikely. It is more likely that you have a seroma although 7.5 cc / day when the drain was pulled is a very low output. Your surgeon of course be able to tell the best by the way they feel and the changes that have occured over the past several weeks.

David E. Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 61 reviews

Can one have a hematoma without bruising and pain?

Looking at your one picture carefully, the left breast doesn't look larger than righ in volumet. It has a different shape. It seems fuller on the upper pole. There was no capsulectomy on the left, therefore the capsul is tighter on that side and the breast looks bigger. The appearance is not unusual when only one side gets the capsulectomy. If there is a fluid collection, it  will be a seroma at this point and if it is assymtomatic I would not wory about it. If my theory is corect a left capsulectomy is the answer. I would suggest to ask your surgeon about these possibilities.

Sonogram will diagnose hematoma or seroma after breast implants


You should have a sonogram right away if a fluid collection is suspected, although it does not sound like you have one.

If you do have a fluid collection, an interventional radiologist can aspirate it under ultrasound control, and so spare you another operation.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Hematoma After Breast Augmentation

As my colleagues have already answered, it is possible to hematoma after your surgery without pain. With the information given, it seems unlikely, however, but no pictures can ever substitute for a direct physical examination which your surgeon has been performing. Certainly imaging such as an ultrasound could delineate the size/volume of the potential hematoma/seroma.

If your surgeon is suggesting that surgical exploration is necessary, the rest of us on this forum are in no place to argue. Ask yourself if you feel comfortable with his/her decisions, and do what you think is right. Best of luck to you.

Derek Lou, MD
Houston Plastic Surgeon
5.0 out of 5 stars 8 reviews

Hematoma after implant exchange

I would certainly want to go with your PS "gut" instinct.  Yes you can have a hematoma without the pain and bruising, though it is not as common.  If it has been a while, see your PS again and discuss your concerns with him/her.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.0 out of 5 stars 17 reviews

Hematoma after breast implant revision

It is possible to develop a hematoma or a seroma after breast implant removal and replacement surgery, and sometimes these fluid accumulations may not present with pain or bruising. If it is not clear whether or not there is a fluid collection in the breast of around the breast implant, an imaging study such as an ultrasound may be performed to confrim the diagnosis.

Olivia Hutchinson, MD
New York Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast hematoma without pain and bruising

It is possible to have a breast hematoma after capsulectomy and replacement without pain or bruising, only a fullness or size discrepancy. The fact that you did have a drain in place does speak against, as the type of drainage and fullness may suggest hematoma to your surgeon earlier rather than later at four weeks. As surgeons we all follow our instincts based on experience and examination. If your surgeon's instincts direct him to drain the breast we should not dissuade him.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 33 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.