Best Course of Treatment for a Hematoma?

Good day! For your guidance, as with any breast revision procedure, it requires drains so that fluid will be generated when you operate on the scar capsule. If a mechanism is provided for the fluid to be removed, such as drains, the risk of getting a hematoma are lower. If there are no drains, the fluid accumulates and causes problems. Ice packs can help but only 20minutes maximum every application. Your nerve endings are still healing after surgery so sensation may not be reliable. It is best to contact your surgeon for detailed information on aftercare and solution for hematoma. Best of luck! #RealSelf100 

Hematoma formation following
breast implant removal can occur for a variety of reasons but is fortunately
rare.When post-operative hematomas are
small, they often resolve spontaneously.Larger hematomas often require treatment to prevent secondary
complications.Treatment may include
repetitive needle aspiration, CT-guided drain placement, or occasionally open
surgical drainage.When large hematomas are not evacuated, there’s an
increased potential for wound breakdown, infection, and scarring.These problems can ultimately impact the
aesthetic result from breast implant removal.Early intervention will ultimately minimize the potential
for complications, improve your aesthetic result, and improve the quality of
recovery.It’s therefore important to
maintain close contact with your plastic surgeon.Your plastic surgeon should be able to
formulate a treatment plan that not only addresses your anatomic findings but
your aesthetic concerns as well.

Given your recent explant and mastopexy surgery, combined with the presence of a hematoma, it's important to follow a careful and informed approach to treatment. Here’s a comprehensive guide tailored to your situation:
Immediate Steps and Management
1. Ice Application:
o When to Use Ice: For the first 48 hours after noticing the hematoma, apply ice packs to the affected area to reduce swelling and pain. Use the ice pack for 15-20 minutes every hour as needed.
o How to Apply: Wrap the ice pack in a cloth or towel to prevent direct contact with the skin, which can cause frostbite.
2. Heat Application:
o When to Use Heat: After the initial 48 hours, switching to warm compresses can help improve blood circulation and facilitate the reabsorption of the congealed blood.
o How to Apply: Use a warm (not hot) compress for 15-20 minutes several times a day.
Pain Management
1. Over-the-Counter Pain Relievers:
o Medications such as acetaminophen or ibuprofen can help manage pain and reduce inflammation. However, avoid aspirin as it can increase bleeding.
2. Rest and Elevation:
o Rest and limit physical activities that could strain the affected area.
o Elevate your upper body slightly when resting to help reduce swelling.
Monitoring and Follow-Up
1. Observe for Changes:
o Monitor the hematoma for any signs of infection (increased redness, warmth, or pus), growth, or changes in symptoms.
o Keep track of any significant changes in the size or feel of the hematoma.
2. Follow-Up Visits:
o Attend all scheduled follow-up appointments with your plastic surgeon to monitor the hematoma’s progression and overall healing.
o If the hematoma does not improve or worsens, your plastic surgeon might consider other interventions.
Special Considerations
1. Avoiding Strain:
o Avoid heavy lifting, strenuous exercise, and activities that might put pressure on the chest area.
2. Support Garments:
o Wear any prescribed support bras or garments as directed by your plastic surgeon to help reduce swelling and support the healing tissues.
When to Seek Immediate Medical Attention
1. Severe Symptoms:
o If you experience severe pain, significant swelling, fever, or any signs of infection, contact your plastic surgeon immediately.
2. Rapid Changes:
o A rapidly expanding hematoma or one that becomes increasingly painful or hard may require urgent evaluation.
Following your plastic surgeon’s guidance is crucial since they are familiar with the specifics of your surgery and recovery process. Using ice packs in the initial phase followed by warm compresses, managing pain with appropriate medications, and monitoring the hematoma closely will help in ensuring proper healing. Always err on the side of caution and consult your plastic surgeon if you have any concerns or if symptoms worsen.

There is not a universal response for the correct treatment of a hematoma as it is unique to each situation.  Your body will take care of smaller hematomas.  Larger ones should either be removed via surgery or drain insertion.  I encourage you to discuss your concerns with your surgeon to better understand his/her point of view.

A sonogram will give an estimate of the size of the hematoma.

If the hematoma is large to cause symptoms, then surgical evacuation and insertion of a drain to  treat hematoma.

It is hard to name a "best treatment" as each patient must be evaluated individually. Larger hematomas can threaten the overlying skin and often are best evacuated either by aspiration, drain placement or surgery. What your surgeon has suggested sounds quite reasonable, and you should be followed up regularly until this is resolved. I would be cautious about ice or heating pads. After a breast lift your sensation may be abnormal, and you may lose protective sensation. Patients have gotten burns or frostbite requiring surgery in that setting. 

All you questions can be best answered by your own surgeon, who has the benefit of an examination that none of the RealSelf physicians have had. Thanks, and best wishes.

very small hematomas will resolve but they are also not visible. the larger ones need to be evacuated otherwise they can lead to more problems.

I'm sorry to hear about the complication you have experienced after breast surgery. Considering that plastic surgeons may vary in their recommendations for treatment course, I think you will be best following your own plastic surgeon's advise. Remember, that he/she is ultimately responsible for your care and that the advice you receive from multiple online consultants can be conflicting and/or confusing.

 Generally speaking, hematomas such as you describe do tend to liquefy over the course of the next few weeks.  At that point, it may be that the blood will reabsorb on its own or be amendable to aspiration.

 Best wishes.