Hematoma 16 Days After Breast Augumentation - Will It Go Away?

It is believed that hematoma may contribute to capsule contracture. The longest I had a patient develop hematoma was 14 days. I took the patient back to the operating room to evacuate the hematoma and stop the source if the bleeding. Patient is now months out and didn't skip a beat. My vote is to reiterate and remove the hematoma.

Thank you for your question and for sharing your photo. 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.

Postoperative
bleeding and resultant hematoma formation can occur following breast
augmentation surgery.When this
situation arises, surgical intervention is usually always indicated to avoid
long-term complications.When blood is left within the
implant pocket following postoperative bleeding, the wound healing process can
be adversely affected.Under these
circumstances, undrained hematomas can result in pain, breast distortion,
capsular contracture, implant displacement, and infections.For these reasons, hematomas should be drained as soon as
possible when they occur after breast augmentation surgery.It’s important that you discuss this
issue with your plastic surgeon.If you’re
unhappy with his response, a second opinion may be appropriate.

Surgery is generally indicated for an expanding or tense hematoma. Othertimes a well contained hematoma that is stable can be allowed to liquefy and then be evacuated with aspiration at 7-10 days using a blunt cannula to avoid implant injury. Small stable hematomas can be observed. In your case, The breast does not look significantly tense or larger than the left and observation could be a reasonable option.

With regards to a hematoma after breast augmentation, it just depends on the size and the symptoms.  From your picture, it appears you have some minor bruising in the lower pole.  This in itself is usually not a reason to go in and drain the hematoma.  However, if the rest of the breast is firm, tense, and painful, then I would go in and evacuate the old blood.  Rarely do you find what caused the bleeding, but old blood sitting around the implant can cause an imflammatory reaction that can lead to more scar tisssue ( capsular contracture) down the line.  I hope this helps.

I treat symptomatic hematomas with surgery to evacuate the blood and stop any persistent bleeding. Small resolving hematomas can be managed with observation. From your photo, it looks like you have a minor bruise which will resolve with time. 

Hematoma 16 Days After Breast Augumentation - Will It Go Away?
I woke up one day with big, painful and hard left breast... it happen almost suddenly! I went to the PS and he did say it was a hematoma and I will see him wednesday again. My question is how often it goes away on its on and how often surgery to drain the blood is necessary? thanks

It is really difficult to say if you have a hematoma or if it really deep bruising.  If it is a formal hematoma, where there is some blood in the pocket, I would address that by removing the blood.  If is just bad bruising, then you just need time.  Only a physical exam can determine the difference.

Good luck.

Anytime there is a change in the breast size, I ask my patient to immediately notify me, such that I can perform an in office examination.   

I would recommend immediate contact with your plastic surgeon as I am concerned by your swelling combined by pain, which is characteristic of a hematoma.   This may require operative intervention to control bleeding, prevent infection, and minimize risk of capsular contracture.

I wish you a safe and healthy recovery.

If you have bruising that is one thing, but if you have a hematoma, then you may need to have the fluid removed.

Regarding: "Hematoma 16 Days After Breast Augumentation - Will It Go Away?
I woke up one day with big, painful and hard left breast... it happen almost suddenly! I went to the PS and he did say it was a hematoma and I will see him wednesday again. My question is how often it goes away on its on and how often surgery to drain the blood is necessary? thanks"

The management of BRUISING and that of a BLOOD COLLECTION (hematoma) are quite different.

Bruising, such as you appear to have on the photograph, will resolve as would a small, non expanding blood collection.

On the other hand, if the affected breast is much larger than the other side and, or is painful, purple, tense than you may have an active bleeding. In such a case, many surgeons would take you back to the operating room, remove the implant, remove the clots in the pocket and look for the bleeding site to stop it. Ignoring a large hematoma may not be wise because such collections may become infected and in most cases they distort the breast and cause scarring  / Capsular Contracture.

I have never seen sudden bleeding 2 weeks after surgery which was not related to trauma or violent coughing or vomiting. From your story you did not have this the day before and woke up with this presentation. I would defer to your surgeon because he is the only one who had the opportunity of examining you.

Dr. Peter Aldea