Hematoma Without Diagnosis of Infection Remove Implant or Clean Hematoma and then Check for Infection?

After having a mini lift and implants I developed a lot of bruising under my right breast by day 10 post op I had a large hematoma on the underside of my breast I did have an unreasoned to confirm it was a hematoma I went to the emergency department to have it drained there was no Indication of infection via blood tests or fever all obs where normal although the hematoma was starting to not allow my nipple to properly heal due to the pressure the drs removed my implant no infection found ?

Doctor Answers (3)

Hematomas around implants need to be drained.

+2

Any hematoma of significance around an implant should be drained.  It is a simple procedure that will reduce the risk of capsular contracture in the future and infection in the present.


Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

Hematoma

+1

I am having a bit of a hard time figuring out what the question is here. From the headline it seems that you may be asking whether the surgeon should have just drained the hematoma or removed the implant.

I don't think any surgeon would disagree with the need to drain a large hematoma. 

You mention there was no indication of infection by blood test or fever--there really are no reliable "negatives" in terms of blood tests. Bacteria in the blood would be a serious finding, but not having that would not exclude the possibility of infection. There is on instantaneous way to identify an infection in the hematoma- cultures taken at surgery take 24-48 hours before the lab can identify bacterial growth. The decision on whether to remove an implant that might be infected is a difficult one, and is base don clinical findings at surgery. Even, by the way if cultures fro surgery were negative, that does not exclude the possibility of infection if, as is customary, you were given antibiotics at the start of surgery. 

You also mention the problem with nipple healing. To me that means the surgeon was worried about whether there was sufficient blood supply for the nipple to survive let alone heal. If removing the hematoma did not immediately improve the blood supply to the nipple and areola, that may be why your surgeon removed the implant. It is much easier to replace an implant at a later time than to try to restore a nipple and areola that are lost to pressure necrosis (tissue death from excess pressure interfering with blood flow).

Thank you for your question. Best wishes for your recovery.

 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Post Breast Augmentation Hematoma

+1

It is difficult to give advice without any photos, but a post operative hematoma should be drained as soon as possible. Without drainage the collection of blood may become infected, potentially leading to an infected implant. It may also lead to capsular contracture or even at times wound healing problems.

Why the implant was removed depends on what your surgeon encountered during your surgery. This is impossible to judge without an in-person exam nor having the advantage of following you during the post operative process. At this point I can only advise you to continue to follow up with your plastic surgeon as he is in the best position to help you. I hope this helps. Good luck

Pedro M. Soler, Jr., MD
Tampa Plastic Surgeon
5.0 out of 5 stars 7 reviews

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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.