Two weeks ago I had augmentation. Within 36 hours I had a fever, a hematoma and an infection. At this point the infection and hematoma have cleared. The hematoma was not drained however fluid was drained from incision site of right breast.(all complication were in the right breast) R breast is still more swollen. I am afraid of capsular contracture. There is a hard spot where the hematoma was. What questions should I make sure to ask my surgeon at our follow up?
Capsular Contracture After Hematoma and Infection
Doctor Answers 13
Prevention of Capsular Contracture
You want to be sure the firm spot is softening with the passage of time, not becoming more firm. Ask your surgeon if he or she believes leukotriene inhibition with zafirlukast or montelukast may be indicated to diminish the chance of capsular contracture. As an aside, true infections after augmentation rarely resolve with antibiotics alone, and nearly always require explantation.
Capsular contracture risk after bleeding and infection
The number one concern with a breast implant infection is recurring inflammation and infection in the breast when antibiotics are withdrawn. The body has a significantly harder time clearing infection when the implant is in place. The sure bet is removing the implant, treating the infection, and replacing the implant at a later time, though is is possible to save the day with antibiotics alone, though temper expectations and work closely with your surgeon. The risk of a capsular contracture with bleeding is about 25% from published information, quite high. Unfortunately you and your surgeon have quite a wall of worry to climb until all is sorted out.
Best of luck,
Undrained hematoma and capsular contracture risk.
The series of events you describe indicates a hematoma, but not an infection. Likely, the redness was related to the increased pressure of fluid which was relieved after it drained from the incision. If you have a substantial hematoma, this can take a long time to resolve. The old blood is broken down by the body via an inflammatory reaction. This will prolong the inflammatory phase within the capsule itself and can lead to capsular contracture. I recommend reoperation and evacuation of a hematoma if it large enough to show a volume discrepancy between the breasts. Otherwise, conservative methods include time, massage, and possible ultrasound therapy to help prevent a capsular contracture.
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I do not believe you had an infection but the hematoma does increase your risk of capsular contracture.
The good news is that I do not believe you had an infection given that they do not usually appear that early. It is more likely that the fever was a result of a problem called atelectasis caused by inadequate expansion of your lungs following the anesthesia used in surgery.. In addition, breast implant infections do not resolve as quickly as yours did especially with the minimal treatment you described. The bad news is that you probably sustained a hematoma and this alone will increase your risk of capsular contracture. Beyond attempting to massage your breast implants there is not much that can be done to definitively prevent a contraction. Possibly the use of a medication called Accolate could help but I am not aware of any studies that demonstrate its efficacy in your situation. However, having a hematoma does not necessarily doom you to a capsular contracture because I have had several post augmentation hematomas that once treated have resulted in naturally soft breasts.
Continue Conservative Management
If your hematoma and infection are resolved I would wait and see how things progress. As others have stated, bleeding or infection in the implant pocket can result in a high incidence of capsular contracture. Whether you need to drain an accumulation of blood after surgery really depends on the extent of the problem. It appears your surgeon treated you conservatively and things improved. The best thing for you to do now is wait and see how your healing progresses.
Hematome/infection post aug
Capsular Contracture after Breast Augmentation: Decreasing the risk
Breast implants are foreign bodies that in general are inert and have minimal reactivity when placed properly in the body. Your body will form a thin capsule around them, however things like bacteria, blood and leaked silicone can lead to a vigorous reaction that likely predisposes to scarring around the implant and capsular contracture. An undrained hematoma or infection can predispose you to a predictable capsular contracture. Medications, like Singulair have shown to maybe decrease and or alleviate early symptoms of contracture. In follow-up, you should inquire about your options regarding treatment, monitoring and need for revisions, including implant warranties. I hope this helps.
Capsular Contracture After Hematoma and Infection
I will not be to 50/50. I believe you "will" have a capsule fibrosis. So you need to discuss in person with your chosen surgeon your options. In my practice if you truly had a bleed with infection, I would have removed the imp[lant to allow treatment of the bleed and infection. From MIAMI
Concerns about capsular contracture following a hematoma and breast infection
Capsular contracture seems to be precipitated by inflammation such as infection and to a lesser extent, hematoma. Though you did state there was an infection, it is not clear that this involved the implant and pocket as opposed to an isolated area on the skin. It would be highly unusual for a significant infection around the implant to resolve without its removal and even more remarkable, in the presence of a hematoma.
You need to discuss the occurrences, present findings and your concerns with your plastic surgeon.
Capsular contracture likely after hematoma and infection.
Ashley, I am sorry to hear of your early post-op right breast hematoma and infection. Drainage through the incision may have evacuated some of the blood collection; however, it is unlikely (particularly with your description of residual localized firmness) that all of the hematoma was eliminated without re-operation. If indeed the hematoma was also infected (which I am doubtful of, since infection around an implant rarely if ever is successfully treated by antibiotic therapy--the implant needs to be removed. Also, infection rarely shows up at 36 hours, even if you had a post-op fever), this even more greatly increases the risk of capsular contracture developing. BTW, antibiotics were absolutely appropriate with drainage from your incision--bacteria can enter if blood or fluid can exit!
I would recommend Singulair (10mg daily) and Vitamin E (400 IU twice daily) to help reduce at least one inflammatory pathway, though definitive scientific evidence is lacking that this leukotriene-inhibitor therapy is truly helpful. I have seen it work several times, and have seen it fail as well. But, since there is nothing else to do but wait and see at this point in time, it seems a reasonable option. I would continue the Singulair and Vitamin E for 3 months and see what develops.
Unfortunately, avoiding prompt re-operation (presumably to save the cost of that procedure) may have increased your risk of capsular contracture requiring a bigger, more difficult, and more costly re-operation in the near future. I perform several hundred breast operations each year, and even with a 1% hematoma rate, that means a hematoma every few months. I ALWAYS recommend prompt (not emergency, but as soon as it is safe to re-anesthetize the patient who may have eaten) hematoma evacuation in the operating room, verification that the bleeding point has been successfully controlled, repeat irrigation with antiseptic, and sometimes placement of steroid (to help reduce increased scar formation) in the pocket. This, along with antibiotic and Singulair therapy, has avoided capsular contracture in almost all of my hematoma patients. Waiting, wrapping the breasts with an ACE bandage or tight surgical bra, and using ice bags are all delay tactics that do not address the true problem, and increase the risk of developing capsular contracture.
Cross your fingers and hope for good luck!