Hematoma Without Bruising or Pain?

My colleagues have given you plenty of good advice to consider, but I would add the following information for consideration. You are just over 1 month post-op R capsulectomy and L capsule revision, and you had drains in each breast for 2 1/2 and 3 weeks! Fluid out and blood out may help to reduce capsular contracture from those standpoints, but did you consider that while the fluid and blood was draining out a few skin or ductal bacteria may have been "sneaking in" around the drain site? Bacteria cause capsular contracture also, and it seems as if this (use of drains) may have potentially caused an early capsular contracture and the fullness you still see and feel on the L breast, rather than a hematoma. Of course, personal examination is much more helpful in arriving at a diagnostic decision than photographs, but I didn't see this possibility mentioned in other answers.

Also, at this point in time, you either watch this and see what happens, or you re-operate, especially if your surgeon really thinks this is a residual or recurrent hematoma. Perhaps this is just a "good reason" for going back in and correcting (whatever) the problem he identifies in the operating room. Sonogram is helpful only if you are trying to decide if you don't need a re-operation. Your appearance says you do, not an ultrasound!

Talk all this over with your surgeon. I suspect you need a complete capsulectomy on your left side like you had on your right, and I would recommend against using drains for the reasons discussed. I would also recommend Accolate or Singulair (luekotriene inhibitors) and oral Vitamin E to help reduce one additional pathway for inflammation-induced capsular contracture. Best wishes!

The left side has a little more superior fullness.  I would obtain an ultrasound in this situation, since the findings are not "classic" for hematoma.  That test should be helpful to clear up the diagnostic confusion.

 

All the best,

You are 4 and a half weeks out, a hematoma without pain is possible and without bruising if you just recently bled is possible as well. But since you are so far out from surgery it is unlikely. It is more likely that you have a seroma although 7.5 cc / day when the drain was pulled is a very low output. Your surgeon of course be able to tell the best by the way they feel and the changes that have occured over the past several weeks.

It is possible to have a hematoma without pain, bruising or hardness. It is difficult to tell what you have just by looking at your photos. Your surgeon has the best vantage point to make decisions concerning your situation and if you trust him then I would suggest that you follow his/her advice. If you are not sure, then a second opinion by a BC plastic surgeon can be helpful. Good luck.

Looking at your one picture carefully, the left breast doesn't look larger than righ in volumet. It has a different shape. It seems fuller on the upper pole. There was no capsulectomy on the left, therefore the capsul is tighter on that side and the breast looks bigger. The appearance is not unusual when only one side gets the capsulectomy. If there is a fluid collection, it  will be a seroma at this point and if it is assymtomatic I would not wory about it. If my theory is corect a left capsulectomy is the answer. I would suggest to ask your surgeon about these possibilities.

I would certainly want to go with your PS "gut" instinct.  Yes you can have a hematoma without the pain and bruising, though it is not as common.  If it has been a while, see your PS again and discuss your concerns with him/her.

It is possible to develop a hematoma or a seroma after breast implant removal and replacement surgery, and sometimes these fluid accumulations may not present with pain or bruising. If it is not clear whether or not there is a fluid collection in the breast of around the breast implant, an imaging study such as an ultrasound may be performed to confrim the diagnosis.

It is possible to have a breast hematoma after capsulectomy and replacement without pain or bruising, only a fullness or size discrepancy. The fact that you did have a drain in place does speak against, as the type of drainage and fullness may suggest hematoma to your surgeon earlier rather than later at four weeks. As surgeons we all follow our instincts based on experience and examination. If your surgeon's instincts direct him to drain the breast we should not dissuade him.

Best of luck,

peterejohnsonmd

Hi.

You should have a sonogram right away if a fluid collection is suspected, although it does not sound like you have one.

If you do have a fluid collection, an interventional radiologist can aspirate it under ultrasound control, and so spare you another operation.

As my colleagues have already answered, it is possible to hematoma after your surgery without pain. With the information given, it seems unlikely, however, but no pictures can ever substitute for a direct physical examination which your surgeon has been performing. Certainly imaging such as an ultrasound could delineate the size/volume of the potential hematoma/seroma.

If your surgeon is suggesting that surgical exploration is necessary, the rest of us on this forum are in no place to argue. Ask yourself if you feel comfortable with his/her decisions, and do what you think is right. Best of luck to you.