Confirmed Hematoma. PS Says to Leave It. Should I Get a 2nd Opinion? It's a Ball of Blood over my Chest ? 1 Wk Post Op. (photo)

I went to see my PS again because my bruising seems to have settled into a mass RIGHT in between both breasts. He says that it is a hematoma but it's not related to the breasts, it's related to bruising and to leave it, it will go away. I now have to wear gauze in the bra, since I couldn't close it otherwise - too much pain and aggravation on the bruise. May have been what caused it in first place. It feels very tight and very scary to have this on my heart!!

Doctor Answers 6

Hematoma or bruising?

You definitely have bruising whether or not you have a hematoma is really dependent upon a physical exam.  

New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Hematoma - significant or not?

Your surgeon is correct that this is technically a hematoma and I concur with him that (while it looks worrisome), it will likely resolve without intervention.  It is not uncommon for there to be some blood in the pocket as a result of the development of the pocket during the operation, but unless it is a major amount (which would likely make the breast on that side look bigger and hurt more) or continues to accumulate, which does require an operation, it is likely to disperse, cause visible bruising, and slowly go away. One concern is that blood in the pocket in significant volume can be an irritant and is believed to contribute to capsule contracture, but this is not something that occurs every time a patient gets a bruise after augmentation. This bruise sits outside your ribcage and should not have any effect on your heart

Jeffrey G. Copeland, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 5 reviews

Skin bruising and ecchymosis does not always signify a large hematoma

Your photos demonstrate significant skin bruising and ecchymosis.  While this can be seen with hematomas, it is but one of many clinical signs that a plastic surgeon will use in deciding whether on not to return to the operating room.  Your photographs provide some information but cannot replace a physical examination to determine if there is increased breast volume to warrant drainage.  You should continue with close follow-up by an experienced plastic surgeon.  A second opinion is necessary if you have lost faith in your treating surgeon.

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 16 reviews

Confirmed Hematoma. PS Says to Leave It. Should I Get a 2nd Opinion?

Although an exam is much more useful than looking at photos, all I have is photos, and I am not very suspicious that this is anything other than a bruise.

What I cannot see on the more recent photos is the entirety of the breasts. If neither side is enlarged, I would not encourage a return to surgery to drain what may not be a hematoma at all. I would never discourage a second opinion to a patient who questions the advice they have gotten.

All the best. 

Blood around the breast should be drained

Its true the more blood around an implant the greater the risk of capsule contracture.  It did not look too bad on day two but both sides looked dramatically more bruised with time.  I suspect you were not still after and moved your arms around more than you should.  Its important to remain still for up to two weeks after surgery or you will have a greater chance of developing a capsule contracture. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 78 reviews

Hematoma of the breast after breast augmentation should be drained.

A significant collection of blood in the pocket after breast augmentation left untreated will increase the risk of capsular contracture dramatically.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 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.