Best Way to Treat a Hematoma After Breast Augmentation?

Breast augmentation 10 weeks ago - at the 5 week post-op mark, plastic surgeon was unhappy with healing and performed a pocket revision for both breasts and bumped up implant size. Within 7 days I developed a mass of fluid below my left breast (size of half a baseball - red and really sore) but PS wasn't overly concerned and prescribed antibiotics and a wait and see approach.

It's been 4 weeks and I still have swelling & pain. PS doesn't want to drain it for fear of risking infection. I am suspect of his approach - what to do?

Doctor Answers 14

Hematoma after breast implant surgery must be drained.

Hematoma after breast implant surgery must be drained.  This is an infrequent complication of breast augmentation, but is probably the one most physicians fear the most.  Plastic surgeons that perform large numbers of augmentation will invariably see and treat patients with this condition -- it happens to all surgeons.  Despite the fact that I have developed a technique to perform breast augmentation and lose less than  a teaspoon full of blood for the entire operation, I have had 2 or 3 patients with post-operative hematomas that I had to drain.

Hematoma after breast augmentation is one of the contributing factors to capsular contracture and even implant infection and therefore need to be drained to help prevent these complications.

It is hard to second guess your surgeon -- he/she has followed you through this process and has been able to examine you and should have a better idea of what should be done.  There are ways to drain fluid collections sterilely and with minimal risk of puncture of the implant.  You may want to discuss these options with your surgeon

Salt Lake City Plastic Surgeon
5.0 out of 5 stars 188 reviews

Hematoma and fluid after breast augmentation needs to be removed

Don't feel bad about getting a second opinion. Any risk of draining the fluid or removing it surgically, especially if it is a hematoma, is negligible compared to the risk of doing nothing. Just leaving it there will be a set up for future complications like capsular contracture, especially with an untreated hematoma which will turn into a fibrotic mass of scar tissue.

Hematoma after breast augmentation

Evacuation is the ONLY way to correctly treat a hematoma, especially after breast implants. I would want to drain the area due to the risk of infection not to try an avoid it. Get another opinion NOW! I

Fluid Collection after Breast Augmentation

The whole story is both confusing and suspect. I am not sure why a surgeon would "bump up" implant size a mere 5 weeks after the augmentation risking operation through inflamed tissue and when facing a seroma / hematoma would risk an abscess or capsular contracture by not getting a diagnostic study (such as an ultrasound) with possible needle guided drainage.

This is not what most of us would do. There must be more to this than has been shared.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 83 reviews

Breast implants and fluid

I agree that this story is a little confusing, but an ultrasound to evaluate the fluid is often helpful if there is still a large amount there. I normally favor draining the fluid to prevent an infection and possible capsular contracture. If you are not receiving a good explanation of what's going on, you could see another surgeon in the area for evaluation and another opinion. Good luck, /nsn.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

You need to have drainage of the fluid

You have described possible hematoma and if it is not removed ,you willl have capsular contracture. Please discuss your concerns with your plastic surgeon and if he is not ready to treat and remove the hematoma/seroma then seek second opnion. You will need to have full explortion and hematom /seroma removal as soon as possible.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 93 reviews

Strange breast augmentation story

What you are describing is most unusual.  The early implant change is strange, the fluid collection isn't normal etc.  I'd agree that an ultrasound would be helpful and the fluid should be draine under almost all circumstances.  Maybe visit another doctor in your area for a second opinion.

Fluid collection following implant removal and replacement

This is a difficult problem to diagnose over the internet and it is hard to second guess the treating physician but based on your description, I would be compelled to drain the collection. One non-invasive option is to obtain an ultrasound to evaluate the mass. While it is possible that an exploration or treatment will result in possible infection, the alternative of not treating could lead to a higher rate of capsular contracture.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

Hematoma after a breast augmentation

It would seem unlikely that you have a hematoma as both breasts are relatively the same size and shape. If unsure see your plastic surgeon for a follow up examination. A small hematoma will resolve on its own a larger hematoma must be drained to prevent future complications.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

Hematoma vs seroma

Thank you for your question. A hematoma can be very mild or very pronounced in its presentation. A mild one may induce slightly more swelling and increased bruising and will likely resolve on its own. A more severe hematoma can result in dramatic asymmetry in terms of swelling, feelings of light headedness due to loss of blood, severe bruising, and can be rapidly growing. If you every experience the latter, then I would contact your surgeon immediately and if you have trouble, you may even go to the ER. Larger hematomas often have to be surgically drained. 
In your situation, your swelling could also be a seroma (inflammatory fluid).  If the size and swelling is steadily decreasing in size, then it is reasonable to continue observing.  Otherwise, it may need to be drained.

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.