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

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.

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.

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