Hematoma or Capsular Contracture After Breast Augmentation?

Question

I had submuscular breast augmentation on January 4, 2010. Here are my post op notes: Silimed: Left side: 315CC Right side: 355CC Gel cohesive siliconeAbout 10 days after surgery, I had a "charlie horse" feeling in my right breast. The breast became very hard and swollen especially in the top of the breast. I have a "shelf" now.I went to the doctor (he did not do my surgery) 2 weeks after surgery and he told me that I had a hematoma but it didn't need to be evacuated. Now almost 4 weeks after surgery the bruising from the hematoma is almost gone but the breast is still as high and hard ans swollen as it was 2 weeks ago.Does that mean I have capsular contracture? I have been applying heat twice a day and taking vitamin E. Is there anything else I can do? The doctor told me to just be patient and "wait and see". I would really appreciate any advice. Thank you.

Farbod Esmailian, MD · Answer

I am a bit confused like the other surgeons.  I am not sure why you did not see the surgeon who operated on you?  Hematomas that are not evacuated usually lead to capsular contracture.  It is difficult to say what is going on with you and how much bleeding you had, but your surgeon could have determined that and may have wanted to remove the blood.
At this point, without examining you and seeing pictures it is difficult to say if you have developed capsular contracture but I would say yes.

Scott C. Sattler, MD, FACS · Answer

It sounds like you have a hematoma around your implant. It must be washed out, which requires another operation. 
You menntioned that you had Silmed implants placed. These are not frequently used in the USA. I'm curious to learn if you had your breast augmentation  surgery done outside of the USA and then sought out the help of a surgeon state-side.

Otto Joseph Placik, MD · Answer

It is nearly impossible to say and I am a little confused as to why you would not return to the surgeon who performed the procedure.
At this point in time, I would recommend obtaining a breast imaging study such as an ultrasound to evaluate the possibility of a drainable fluid collection.

Nina S. Naidu, MD, FACS · Answer

This is really hard to answer without an examination.  However, it sounds like you had a hematoma, which is now forming a capsular contracture.  We do know that hematoma is associated with a higher risk of contracture.  
I personally would have opted for taking you back to surgery a few weeks ago to evacuate the hematoma, but at this stage it makes sense to get an ultrasound and see if there is any fluid sitting in the breast which could be removed (ask your current surgeon if he can order this for you).  Massage is fine and will not hurt anything, but it probably will not change your breasts significantly at this time.  I hope this helps, good luck.

Scott E. Kasden, MD, FACS · Answer

Hard to tell exactly what is going on without an actual exam.  I would suggest a frank discussion with your plastic surgeon.  A band or massage may be in order. You need information to make a plan.

Francisco Canales, MD · Answer

HI Elise
You have not told us what happened in the first week.  Did you have any problems right after surgery? How come you did not see your own surgeon when you had a problem? Usually we remove sutures about 7 days after surgery, and we can certainly see if there is a postop hematoma.  The problem with a hematoma that is 2-4 weeks old is that it may be too late to evacuate as it may not be in a liquid state.  I would certainly go back to your original surgeon for evaluation.

George J. Beraka, MD (retired) · Answer

Hi.
Going just by what you say, I would have evacuated the hematoma as soon as it happened, because there is evidence that even a small hematoma significantly increases the risk of capsular contracture.
There is nothing to do now.  You may need a revision breast augmentation in a few months.

David B. Reath, MD (retired) · Answer

Hi Elise.
Sounds like you have had a time of it.  In all likelihood you now have a capsular contracture.  It may improve with some very vigorous massage.  But it may not.  I would not recommend that you do anything other than massage at this point.  The nature of the scar tissue may change significantly over the next several months.  So, it's a bit of a wait and see proposition at this point.  This is a not uncommon side effect of hematomas that are not evacuated.
I agree with the wait and see approach.  There is not much else to be done currently.
Best of luck,
David B.

Richard P. Rand, MD, FACS (retired) · Answer

As Dr. Placik said you should be seen by your operating surgeon. Most hematomas need to be evacuated because they lead to a higher incidence of capsular contractures. Possibly because the doctor you saw wasn't your's, they didn't want to do that but maybe should have. At least have an ultrasound immediately to see if there is a lot of fluid that needs drainage.

Hematoma or Capsular Contracture After Breast Augmentation?

Answers (9)

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