Hematoma after Breast Augmentation- no treatment after unsuccessful syringe drainage?

Question

I developed a hematoma immediately after breast augmentation surgery (swollen, high, painfully right and bruised) I was seen a few days later and my surgeon said it looked normal however at the two week checkup my surgeon assessed it as a hematoma and unsuccessfully drew fluid through a syringe. I was told t will just absorb. I am now looking red and still sore. I also have bruising down my rib cage and on my inner arm. is this normal treatment if fluid drainage was not successful? Thank you!

Kenneth Dembny, II, MD · Answer

I am sorry to hear about this unexpected
outcome. Significant asymmetric swelling, and almost any kind of bruising, is
uncommon after a successful breast augmentation procedure. In fact, the type of
swelling, pain, and bruising you describe is a very typical presentation for a
post-operative hematoma. The risk of developing a hematoma following breast
augmentation surgery is approximately 1%.

Such a hematoma may contain some liquid blood,
but it often contains clotted blood as well. The appropriate treatment for a hematoma
following breast augmentation is a re-operation to evacuate/drain the fluid and
clot. And there is no reason to delay this operative intervention. This
procedure should be performed in the operating room. The patient should be
thoroughly prepped and draped, all of the hematoma removed, the bleeding source
stopped, and the implant cavity thoroughly washed and irrigated with antibiotic
solution. Failure to treat anything but a very small-sized hematoma with
re-operation and drainage will result in capsular contracture, including breast
firmness, asymmetry, and pain.

I would never recommend needle aspiration for
a hematoma because it is very unlikely that the hematoma will be adequately
drained, and because there is significant risk for violating the implant shell.
(The last thing you want is to worry about the need for replacing the breast
implant as well.)

A small sized hematoma may be left to resolve
in its own; these usually don’t present the first day or two post-op. And any
signs of hematoma that include asymmetric swelling, pain, and visible bruising
(these usually present within the first couple days) are indications that the
hematoma is significant enough to require operative intervention.

The bruising you described results from the
blood dissecting thru the tissue planes and becoming visible beneath the skin.
This bruising will usually spread and move with gravity as well. Pain results
from the increased pressure beneath the muscle. If you are developing more
redness, it is important to rule out potential infection. You should discuss
your concerns with your surgeon again. If you still feel that you need for
information or a different treatment, a second opinion may be helpful. Best
wishes for a successful recovery.

Young R. Cho, MD, PhD · Answer

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.If your surgeon has attempted drainage and little came out, then you may want to consider following up closely with your surgeon to assess whether it resolves on its own or whether an open drainage procedure is needed.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Your treatment of a hematoma the breast augmentation is a little strange. I rarely get breast hematomas. If I were to get a hematoma I would treat it very aggressively by surgical drainage in the office or in the operating room.  If I hematomas left you can easily become infected. This infection can lead to capsular contracture down the road.You need to have this treated.Earl Stephenson Jr MD DDS FACS

Douglas L. Gervais, MD · Answer

Dear Florida 121221,  Without examining you, you are describing a post-operative hematoma. Placing a needle into the pocket is rarely successful. This should be treated in an operating room with sterile conditions. The hematoma needs to be evacuated, the bleeding stopped and the pocket rinsed thoroughly with antibiotic solution. You are at a higher risk of capsular contracture after a hematoma and I would recommend starting Singulair and vitamin E as prophylaxis. I would suggest going back to your surgeon and discussing this option. Best of luck. #Dr. Gervais.

M. Scott Haydon, MD · Answer

Thanks for your question. Sorry for your problems. Hematoma following augmentation is uncommon (1-2%). Sometimes it is a large amount seen immediately or it could present a few weeks later. The fluid sometimes is very thick and difficult to aspirate through a syringe. If there is a significant size asymmetry and your surgeon feels like there is a hematoma, then you likely will need to return to the OR for a quick evacuation and wash out. If it is fairly small, then your body can usually absorb it on its own. Best of Luck!

Hematoma after Breast Augmentation- no treatment after unsuccessful syringe drainage?

Answers (8)

Answer: Augmentation Hematoma

Answer: Augmentation Hematoma

Answer: Hematoma may need to be drained in the OR

Answer: Hematoma may need to be drained in the OR

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Everything you need to know about Breast Augmentation

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Hematoma after Breast Augmentation- no treatment after unsuccessful syringe drainage?

Answers (8)

Answer: Augmentation Hematoma

Answer: Augmentation Hematoma

Answer: Hematoma may need to be drained in the OR

Answer: Hematoma may need to be drained in the OR

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.