Should a Small Hematoma Just Be Observed or Immediately Drained to Reduce Risk of Cc?

I had my breast augmentation surgery on a Tuesday, and on Wednesday my PS observed my right breast had a small hematoma. He wants me to come back in 48 hours to observe if it has stabilized. I am nervous about the increased risk of capsular contracture and was wondering if it is better to just clean it out, even if it is a small hematoma, or just let my body absorb it. What is the link between small hematomas and cc? I am not in pain, haven't taken any pain meds. Just nervous about cc now.

Doctor Answers 2

Hematoma after breast augmentation

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The blood of a hematoma if left alone tends to consolidate into scar tissue over time, and this can contribute to capsular contracture.  A small amount may be acceptable, and some negligible amount of blood within the operated space probably happens in virtually every case.  But how much is too much?  That is a question that doesn't have an easy answer.  For some surgeries a small hematoma can be watched and perhaps aspiration attempted (usually after several days when it tends to liguify for a period of time), or left alone to resolve on its own with no consequence.  (This of course assumes the hematoma is not enlarging which would indicate continued bleeding which would need surgery to stop).  But with breast augmentation, any recognized hematoma is probably big enough to cause problems, and the safest option is usually to remove it.  Typically, this means surgery to open the incision and wash out the hematoma.  Sticking needles into the breast pocket next to the implant has some obvious risks.

Capsular Contracture: The Relationship with Hematoma

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Capsular contracture is caused by inflammation around breast implants.  In some cases, the cause is likely bacterial, and in other cases, the cause may be due to blood or blood products which collect around the implant.  A collection of blood around an implant stimulates inflammation and scar tissue formation.  For my patients, any significant collection or hematoma is drained surgically.  This does reduce the chance of encapsulation but may not eliminate it completely.  For a patient with a small hematoma after breast augmentation, the surgeon is best to disucss the options and both advantages/disadvantages of treatment or observation so that the best plan can be carried out.  

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

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