Hematoma After Breast Reduction Surgery

Question

Hello, 19 days ago I've done breast reduction and lift (I had a C+ and asked 40% less, which doctor said he did). The problem is that my left breast is twice as swollen as the right one. Surgeon says it is a hematoma and I should just wait for it to go. Could you please tell me if this is normal? how long to wait? what if doesn't go away? thank you.

Michael A. Epstein, MD, FACS · Answer

Hematoma is certainly one of the more common complications that can occur with breast reduction surgery. While there is no exact right answer, generally, if the involved breast is over 1.5 times the size of the other breast, I will typically drain this. More importantly, if I feel the hematoma will have a detrimental affect (wound healing,skin loss, infection) on the involved breast I will recommend a drainage procedure of some sort. This could be needle aspiration or an open procedure. A second opinion is worth while if you do not trust the answer you are getting from your surgeon.

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.

Richard J. Bruneteau, MD · Answer

Hematoma formation
following breast reduction surgery can occur for a variety of reasons, but is
fortunately rare. When post-operative hematomas are small, they often resolve
spontaneously. Larger hematomas often require treatment to prevent secondary
complications. Treatment may include repetitive needle aspirations, CT guided
drain placement, or occasionally open surgical drainage.

When large hematomas
are not evacuated there’s an increased potential for wound breakdown, infection
and scarring. These problems can ultimately impact the aesthetic result from
breast reduction.

Since your left
breast is almost twice the size of your right breast, treatment is definitely
indicated. Early intervention will ultimately minimize the potential for
complications, improve your aesthetic result, and improve the quality of
recovery.

Paul Vitenas, Jr., MD · Answer

Hematomas may occur following breast reduction surgery. They can be managed medically or surgically. If the hematoma is quite large and causing pain needle aspiration can be done in the office with quick alleviation of symptoms. Uncommonly a patient has to go back to surgery for exploration and control of bleeding causing the hematoma. Smaller hematomas can be watched and allowed to liquefy and drain.

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

Hematoma can occur with breast reduction. The best treatment is to remove the hematoma.  This will decrease the chance of that hematoma becoming infected.  You should opt for treatment and not wait.

Otto Joseph Placik, MD · Answer

This depends on when the hematoma occured. Typically 7-10 days after a hematoma, the collection becomes a liquid and it can be emptied using a liposuction cannula or needle.

David Mattos, MD · Answer

Hematomas unfortunately happen to 1-2% of patients who have surgery, including for breast reductions. The decision to drain a hematoma surgically versus just let it dissolve away on its own depends on a few things: 1. the size of the hematoma, 2. how uncomfortable the patient is, 3. whether it's causing compression or loss of blood supply to the nipple or any other part of the breast, and 4. if it's getting bigger in size. If you have a small hematoma that is not causing you discomfort and is not compressing anything or getting bigger, it is ok to keep an eye on it and let the body break it down and dissolve it. The whole process can take about 2-3 months, so I typically only do this if the breast is barely different in size and very minor. Anything bigger than that I typically take to the operating room and drain it so that the patient can recover a bit faster and move on with her life. 
-Dr. David Mattos, New York Plastic Surgical Group

Jeffrey Zwiren, MD · Answer

Hematomas can occur after any surgery including breast reduction. Some surgeons place drains other do not. A significant hematoma can occur even when drains are used, so a drain will not prevent this from occurring. If your breast is twice as large as the other side then this is a hematoma that may need to be surgically drained as it can have a detrimental effect on healing causing more pain, stiffness of the soft tissue and generally delaying an otherwise uneventful recovery.

Tom J. Pousti, MD · Answer

Thank you for the question.

	I'm sorry to hear about the complication you have experienced after breast reduction surgery.

	If you and your surgeon have elected to manage the hematoma on surgically,  it may take several weeks for the hematoma to &ldquo;liquefy&rdquo;. Application of warm compresses over the area may help expedite this process.

	If the hematoma is such that there is potential for compromise of blood flow to the surrounding tissues,  it should be evacuated ( and not managed expectantly).

	Best wishes for an otherwise uneventful recovery.

Steven Wallach, MD · Answer

If you have a significant hematoma in one breast, you probably should have it evacuated because this could compromise the viability of the nipple or skin flaps.

Hematoma After Breast Reduction Surgery

Answers (15)

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