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Best Way to Treat a Hematoma After Breast Augmentation?

Breast augmentation 10 weeks ago - at the 5 week post-op mark, plastic surgeon was unhappy with healing and performed a pocket revision for both breasts and bumped up implant size. Within 7 days I developed a mass of fluid below my left breast (size of half a baseball - red and really sore) but PS wasn't overly concerned and prescribed antibiotics and a wait and see approach.

It's been 4 weeks and I still have swelling & pain. PS doesn't want to drain it for fear of risking infection. I am suspect of his approach - what to do?

Doctor Answers 14

Hematoma vs seroma

October 18th, 2015
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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. 
In your situation, your swelling could also be a seroma (inflammatory fluid).  If the size and swelling is steadily decreasing in size, then it is reasonable to continue observing.  Otherwise, it may need to be drained.
Young R. Cho, MD, PhD
October 18th, 2015

Hematoma vs seroma

{{ 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. 
In your situation, your swelling could also be a seroma (inflammatory fluid).  If the size and swelling is steadily decreasing in size, then it is reasonable to continue observing.  Otherwise, it may need to be drained.
Young R. Cho, MD, PhD

Breast implants and fluid

February 18th, 2010
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I agree that this story is a little confusing, but an ultrasound to evaluate the fluid is often helpful if there is still a large amount there. I normally favor draining the fluid to prevent an infection and possible capsular contracture. If you are not receiving a good explanation of what's going on, you could see another surgeon in the area for evaluation and another opinion. Good luck, /nsn.

Nina S. Naidu, MD, FACS
February 18th, 2010

Breast implants and fluid

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I agree that this story is a little confusing, but an ultrasound to evaluate the fluid is often helpful if there is still a large amount there. I normally favor draining the fluid to prevent an infection and possible capsular contracture. If you are not receiving a good explanation of what's going on, you could see another surgeon in the area for evaluation and another opinion. Good luck, /nsn.

Nina S. Naidu, MD, FACS

You need to have drainage of the fluid

February 18th, 2010
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You have described possible hematoma and if it is not removed ,you willl have capsular contracture. Please discuss your concerns with your plastic surgeon and if he is not ready to treat and remove the hematoma/seroma then seek second opnion. You will need to have full explortion and hematom /seroma removal as soon as possible.

Kamran Khoobehi, MD
February 18th, 2010

You need to have drainage of the fluid

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You have described possible hematoma and if it is not removed ,you willl have capsular contracture. Please discuss your concerns with your plastic surgeon and if he is not ready to treat and remove the hematoma/seroma then seek second opnion. You will need to have full explortion and hematom /seroma removal as soon as possible.

Kamran Khoobehi, MD

Hematoma after a breast augmentation

November 7th, 2015
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It would seem unlikely that you have a hematoma as both breasts are relatively the same size and shape. If unsure see your plastic surgeon for a follow up examination. A small hematoma will resolve on its own a larger hematoma must be drained to prevent future complications.
Jeffrey Zwiren, MD
November 7th, 2015

Hematoma after a breast augmentation

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It would seem unlikely that you have a hematoma as both breasts are relatively the same size and shape. If unsure see your plastic surgeon for a follow up examination. A small hematoma will resolve on its own a larger hematoma must be drained to prevent future complications.
Jeffrey Zwiren, MD

Hematoma and fluid after breast augmentation needs to be removed

February 23rd, 2010
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Don't feel bad about getting a second opinion. Any risk of draining the fluid or removing it surgically, especially if it is a hematoma, is negligible compared to the risk of doing nothing. Just leaving it there will be a set up for future complications like capsular contracture, especially with an untreated hematoma which will turn into a fibrotic mass of scar tissue.

Douglas J. Mackenzie, MD
February 23rd, 2010

Hematoma and fluid after breast augmentation needs to be removed

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Don't feel bad about getting a second opinion. Any risk of draining the fluid or removing it surgically, especially if it is a hematoma, is negligible compared to the risk of doing nothing. Just leaving it there will be a set up for future complications like capsular contracture, especially with an untreated hematoma which will turn into a fibrotic mass of scar tissue.

Douglas J. Mackenzie, MD

Hematoma after breast augmentation

February 23rd, 2010
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Evacuation is the ONLY way to correctly treat a hematoma, especially after breast implants. I would want to drain the area due to the risk of infection not to try an avoid it. Get another opinion NOW! I

Darryl J. Blinski, MD
February 23rd, 2010

Hematoma after breast augmentation

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Evacuation is the ONLY way to correctly treat a hematoma, especially after breast implants. I would want to drain the area due to the risk of infection not to try an avoid it. Get another opinion NOW! I

Darryl J. Blinski, MD

Fluid around breast at 2.5 months after augmentation

February 22nd, 2010
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Wow this is one of the most interesting situations I've hear of yet.  First I'm baffled by why your surgeon when back in at 5 weeks.  If I have any concerns I wouldn't consider going back in until 6-8 months later.  The breasts need to heal before any revision is considered.

The mass you have needs to be opened up and cleaned out.  The risk of infection is high with any fluid collection around the implant so it needs to be removed.

My advise, find another surgeon who understands what needs to be done.

Christopher L. Hess, MD
February 22nd, 2010

Fluid around breast at 2.5 months after augmentation

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Wow this is one of the most interesting situations I've hear of yet.  First I'm baffled by why your surgeon when back in at 5 weeks.  If I have any concerns I wouldn't consider going back in until 6-8 months later.  The breasts need to heal before any revision is considered.

The mass you have needs to be opened up and cleaned out.  The risk of infection is high with any fluid collection around the implant so it needs to be removed.

My advise, find another surgeon who understands what needs to be done.

Christopher L. Hess, MD

Fluid Collection after Breast Augmentation

February 18th, 2010
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The whole story is both confusing and suspect. I am not sure why a surgeon would "bump up" implant size a mere 5 weeks after the augmentation risking operation through inflamed tissue and when facing a seroma / hematoma would risk an abscess or capsular contracture by not getting a diagnostic study (such as an ultrasound) with possible needle guided drainage.

This is not what most of us would do. There must be more to this than has been shared.

Peter A. Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.8 out of 5 stars 114 reviews

February 18th, 2010

Fluid Collection after Breast Augmentation

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

The whole story is both confusing and suspect. I am not sure why a surgeon would "bump up" implant size a mere 5 weeks after the augmentation risking operation through inflamed tissue and when facing a seroma / hematoma would risk an abscess or capsular contracture by not getting a diagnostic study (such as an ultrasound) with possible needle guided drainage.

This is not what most of us would do. There must be more to this than has been shared.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Fluid collection following implant removal and replacement

February 17th, 2010
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This is a difficult problem to diagnose over the internet and it is hard to second guess the treating physician but based on your description, I would be compelled to drain the collection. One non-invasive option is to obtain an ultrasound to evaluate the mass. While it is possible that an exploration or treatment will result in possible infection, the alternative of not treating could lead to a higher rate of capsular contracture.

Otto Joseph Placik, MD
February 17th, 2010

Fluid collection following implant removal and replacement

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

This is a difficult problem to diagnose over the internet and it is hard to second guess the treating physician but based on your description, I would be compelled to drain the collection. One non-invasive option is to obtain an ultrasound to evaluate the mass. While it is possible that an exploration or treatment will result in possible infection, the alternative of not treating could lead to a higher rate of capsular contracture.

Otto Joseph Placik, MD

Postoperative Hematoma - What to Do

January 16th, 2015
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Post-operative bleeding and resultant hematoma formation can occur following breast augmentation surgery. When this situation arises, surgical intervention is usually always indicated to avoid long term complications.

When blood is left within the implant pocket following post-operative bleeding the wound healing process can be adversely effected. Under these circumstances, undrained hematomas can result in pain, breast distortion, capsular contracture, implant displacement, and infections. For these reasons, hematomas should be drained as soon as possible when they occur after breast augmentation surgery.

It’s important that you discuss this issue with your plastic surgeon. If you’re unhappy with his response a second opinion may be appropriate. 

Web reference: http://www.surgicalimages.com/plastic-surgery/breast-augmentation.cfm

Richard J. Bruneteau, MD
January 16th, 2015

Postoperative Hematoma - What to Do

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

Post-operative bleeding and resultant hematoma formation can occur following breast augmentation surgery. When this situation arises, surgical intervention is usually always indicated to avoid long term complications.

When blood is left within the implant pocket following post-operative bleeding the wound healing process can be adversely effected. Under these circumstances, undrained hematomas can result in pain, breast distortion, capsular contracture, implant displacement, and infections. For these reasons, hematomas should be drained as soon as possible when they occur after breast augmentation surgery.

It’s important that you discuss this issue with your plastic surgeon. If you’re unhappy with his response a second opinion may be appropriate. 

Learn more: http://www.surgicalimages.com/plastic-surgery/breast-augmentation.cfm

Richard J. Bruneteau, MD

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.