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

Question

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?

Jason Hess, MD · Answer

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.

Thomas Trevisani, MD · Answer

This is best answered by your Operating Surgeon. This is a question he/she needs to deal with now. Hematoma and infection have different signs and symptoms. Your Surgeon will be able to tell

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.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.

Raffy Karamanoukian, MD, FACS · Answer

Both concerns are possibilities.  For that reason, it would require the expertise of a surgeon, preferably your own, and a physical examination.

Otto Joseph Placik, MD · Answer

This may be a tough diagnosis to make and I understand your anxiety over the matter. I would remain in close contact with your surgeon and his /her staff.

Nora Nugent, FRCSI (Plast) · Answer

Dear danilas,
Thank you for posting your question. I would strongly urge you to contact your plastic surgeon for an appointment to review you if you have these concerns. Without examining you, it could be any of the three problems that you have mentioned although it is very early and you are unlikely to have a capsular contracture at this stage. There is usually some bruising if a haematoma is present and the breast may feel hot or have a discharge if an infection is present. However, this is really best assessed with an in-person exam. If treatment is needed, early is better than late. Please contact your plastic surgeon for advice.
Best wishes

Robert D. Wilcox, MD · Answer

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.

Paul Gill, MD · Answer

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.

David Bogue, MD · Answer

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.

Barry L. Eppley, MD, DMD · Answer

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.

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