Hematoma treatment after breast implant?

I've developed a hematoma 8 days right after my breast aug. My doctor been squeezing my breast for 5 days now to drain the blood (huge amount) in order to avoid the surgical evacuation! I'm concerned about his approach and wonder if surgery is necessary! would appreciate second opinion. Thx

Doctor Answers 2

BAM and hematoma

Hi Emma.

Sorry about your complication.

The decision to operate or not is a clinical one best made by the doctor who has the benefit of exam and knowledge of the patient.  That said, it is usually ok to let small hematomas resolve on their own.  On the other hand, large hematomas should be drained, pocket irrigated, and antibiotics should at least be considered.

In your case, I am concerned that you have communication between the skin and the implant pocket.  This sounds risky for infection and capsular contracture.

Surgical treatment should not be a big deal.

Best of luck to you.

sek

Hematoma treatment after breast implant?

I understand the reluctance to cause another set of operating room, hospital, anesthesia, and other costs for surgical hematoma drainage (even with no surgeon's fee), but "kicking the can down the road" for the surgical costs of a capsular contracture operation in 6-12 months seems, well, as poorly advised as you appear to intuitively understand.

You see, most plastic surgeons agree that capsular contracture occurs as a result of bacterial biofilm and/or bleeding, the latter either causing capsule scar fibrosis on its own or acting as "culture broth" for bacteria and the resultant biofilm stimulating capsular contracture. Either way, your breast implant has blood around it right now (huge amount, to use your words) and a hole leading to the outside, which also allows bacteria IN.

Not good.

As opposed to the "toothpaste squeeze" approach to hematoma treatment, most of us would even prefer a semi-sterile office procedure with a sterile suction tool to evacuate as much of the blood as possible (and surgical reclosure), and we would all likely agree that's still less than ideal. Any surgeon who has done this operation (BA) enough has had to deal with a hematoma, and it always is amazing how sticky the clots are, and how difficult it is to completely remove the adherent blood even with a fully open incision in the operating room, so you know that your surgeon's approach is only relieving some of the pressure but not really eliminating all the excess blood, and incompletely reducing the risk (still elevated, BTW) of subsequent capsular contracture.

Most of us would bite the bullet and take you to the operating room (though you should verify the costs first--they will shock you) and surgically drain this, rinse everything out with antibiotic or Betadine, and many would add Singulair and Vitamin E, or intrapocket or oral steroids. Your surgeon's approach is not wrong per se, but I share your skepticism, and this at least bears a difficult discussion with your surgeon (understanding that the hidden discussion is really about who pays for what and how much it is.) Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 239 reviews

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