How Do I Know if I Have an Infection or Hematoma After Breast Implant Surgery?

I had silicone breast implants placed 15 days ago. The left is soft and painless. The right is painful and harder to the touch. I had bilateral capsular contractures with saline implants in the past and am very concerned. Could this be an infection? Hematoma? Or contractures again?

Doctor Answers 14

Hematoma or infection

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In short, your symptoms could be any of the three that you mentioned.  Hematoma is generally accompanied by bruising, and your affected breast will be larger than the unaffected one.  Infection may or may not be associated with fever.  I generally ask my patients to begin breast massage soon after implant placement.  There is some evidence that this can help reduce the occurrence of capsular contracture.  Additionally, Accolate or Singular may contribute to the avoidance of capsular contracture.  It would be wise to see your doctor ASAP.  He or she will be able to diagnose this with a good physical exam and possibly labs. If these issues are addressed early, they are inconsequential, but the longer time between diagnosis and treatment, the worse the outcome.

San Diego Plastic Surgeon

Hard Breast Atter Recent Breast Augmentation Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Since you have two breasts and both had the same procedure, it is understandable that you would be concerned about how different they feel after recent surgery. In theory, the harder right breast should feel more similar to the left and should not be considerably more painful at this point after surgery. You should return to your treating plastic surgeon immediately and discuss your options. It will not be a capsular contracture at this early point after surgery, but it may be a small hematoma or fluid collection.

Firm, painful breast 15 days after surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Please go back to your surgeon for a personal evaluation.  With your history of prior capsular contracture, I'm assuming that you had more done than just a simple breast implant exchange.  15 days after surgery, it's possible to have a hematoma or seroma. With a hematoma, you might see new bruising on the breast, but not always.  With a seroma, you might feel a fluid wave or "swishing" in the breast, but not always.

The fact that your breasts are so different at this point is reason to see your surgeon again ASAP.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

You might also like...

Infection Answers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Stlrmiebrooke,


Whenever we do bilateral surgery, one side is always going to hurt more, bruise more and swell more, so that in itself is not alarming.  It is difficult to tell with the picture as it is not very clear, but your best option is to be reassessed by your PS.  Remember the signs of infection are swelling and hardness of the area, redness, warmth and pain.

Robert D. Wilcox, MD
Dallas Plastic Surgeon
4.1 out of 5 stars 22 reviews

Breast hematoma vs infection

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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 you are having fever and chills as well as swelling of the breast, then this could be sign of infection rather than hematoma.  I would visit with your plastic surgeon who can better assess your situation.

Hematoma vs Infection after Recent Implant Exchange

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you have drains, this should be pretty easy to figure out.  If not, infection will present with fever, redness, soreness, and swelling.  Anytime there is a change in the breast size, I ask my patient to immediately notify me, such that I can perform an in office examination.   

I would recommend immediate contact with your plastic surgeon as I am concerned by your swelling combined by pain, could be a characteristic of a hematoma.   This may require operative intervention to control bleeding, prevent infection, and minimize risk of capsular contracture.

I wish you a safe and healthy recovery.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Pain and hardness early after breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

From the symptoms you describe and the time frame, infection and hematoma are most likely. Capsular contracture typically takes at least 4 to 6 weeks before setting in. It is important to follow up with your surgeon as soon as possible.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Painful Hard Breast

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I think your concern is very reasonable due to the fact that one breast has no problem and you have had capsular contracture in the past. These are concerns that I would want to be made aware of if I were your surgeon. Please call him(or her) to be seen very soon. Good luck!

James M. Kurley, MD
Champaign Plastic Surgeon
4.8 out of 5 stars 39 reviews

Early post-op issues after implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

After having implant exchange surgery and removal of capsules, it is likely that one breast required more work than the other.  But, any questions this early should be directed to your surgeon if you are worried about a possible hematoma.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Early Post-op Concerns Need to be Directed to Surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

No one can tell you if you have a hematoma or infection from the information you provided.  This should be addressed by your surgeon as soon as possible.  Even if it does represent a hematoma, that hematoma can become infected if not properly and timely treated.

John Whitt, MD (retired)
Louisville Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.