What would happen if I chose to let my hematoma just drain? My incision has been draining for days now. Will I get CC? (photo)

Question

Ok so according to my previous questions all surgeons say that I should have the pocket cleaned out and the blood removed from the breast. I was told by my surgeon to wait it out. He does not want to go back in due to the fact that it might cause infection. He says that it will heal on its own and not to worry about it. I am definitely worried! Every response I got from here says for it to be removed. Can this actually heal on its own and everything be ok? I had silicone under the muscle.Imonabx

Ali Sajjadian, MD, FACS · Answer

Thanks for your question and photosI would recommend going back to your surgeon and explain your fears and concerns.In my practice, i would have gone back to the OR and remove the blood clots. I would explore to make sure there are no other bleeding sites and apply irrigation with triple antibiotics saline solution and then I would close over drains. Best Wishes

Robert M. Wald, Jr., MD · Answer

Bleeding around a breast implant has a much higher incidence of capsular contracture and potential for infection. Treating this conservatively is not the standard of care. As plastic surgeons, complications occur and have to be dealt with. We would all like to treat these conservatively without reoperation, but our teaching is to treat more aggressively to prevent future problems. I would suggest you get a second opinion to clarify your problem. All of us online have not seen you in person and can't give you an exact answer.

Lewis Albert Andres, MD · Answer

Thank you for your question!  Certainly postoperative hematomas of the breast with implants have a much higher chance for infection as well as capsular contracture. Also, there is a significant higher incidence of wound healing issues, as the liquefied blood clot will attempt to egress from the breast pocket.  I would recommend exploration and evacuation of the breast. There are risks and benefits of everything done in surgery, but I believe the advantages outweigh any disadvantages for this issue. Best wishes!

Richard H. Tholen, MD, FACS · Answer

None of us here has all the facts that your own surgeon does, but for a breast augmentation patient whose incision has been draining blood, this is also a way for bacteria to enter the implant space. Bleeding plus or minus bacteria equals capsular contracture (or implant removal). Antibiotics cannot sterilize an already-contaminated implant, only prevent you from getting sick from bacteria entering your bloodstream. They're already in that draining wound, even with antibiotics.Let me guess--your surgeon performs surgery at a hospital, and re-operation would cost $$$. Who pays? If this wasn't discussed before surgery, it better be discussed right now. Waiting will not end well, and in fact, you may have already waited too long for a satisfactory outcome. "Going back in" does NOT cause an infection--your open wound can cause an infection!!!Unless you also had a lift and a separate space where bleeding could occur and drain from that is NOT connected to your implant pocket, this blood is coming from your pocket, and your implant is already contaminated. Even if you were "lucky" and avoided an infection, your likelihood for capsular contracture is way more than 50%. Have a long, hard discussion with your surgeon, and then get a second opinion or two. It may already be too late for the expected outcome, but may be soon enough to avoid a bigger disaster. Best wishes! Dr. Tholen

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Are you getting incorrect advice. Leaving the hematoma will definitely need to an infection and capsular contracture. Cleaning it out with minimize the chance of infection. You may have to get a second opinion.

Jose Perez-Gurri, MD, FACS · Answer

Hi and thanks for your question. Acute expanding hematomas should be drained. However,  an old hematoma that begins o drain through the incision site can be treated conservatively.After 29 years of performing beast augmentations in the land of breast implants, Miami, fl., I have seen a few. Some, I have taken back to surgery immediately and some, I have treated conservatively. If you have implant exposure then I would suggest that you go back to surgery. However, as your pictures show, you have a slow constant ooze of dark old blood, it is my opinion that you can wait it out.There is a high likelihood that you will go on to form a capsule contracture. Of the patients that I have treated conservatively in my practice about 50% went on to form a capsule contracture. Of that 50% a very small percentage were Class IV and required a capsulectomy.Follow your surgeon's advice and continue an opne dialogue. Good luck.

Curtis Wong, MD · Answer

Your surgeon has the best idea of where this hematoma may be... if its inside the pocket and with your implant, every surgeon would recommend re-exploration, evacuation of hematoma and control of bleeder (if applicable).   If your involved side is much larger than the other side, you should have surgery and if communicating with the implant, you will have tough decision as to whether to take the chance and close the wound at risk of an infected implant or removing implant and waiting to heal before going back in.  I counsel my patients to take the chance... if it works, everyone is happy.  If it doesn't, you are no worse off then if you had the implant removed at the time of surgery and the infected implant will have to come out.Perhaps yours is in the subcutaneous tissues and not involving the 
implant.  In that case, observation is okay but you must really protect 
the wound from contamination.

Darryl J. Blinski, MD · Answer

Sorry to say in my opinion you are too late (over 3 weeks from surgery) to prevent a capsule contracture now due to the delay in operative drainage! BUT you still need manuel irrigation and removal of the hematoma!!! By waiting "ALL" this time with all these postings here on RealSelf the standing/pooling blood has initiated fibrosis or capsular formation. I do not understand your surgeon's reluctance to drain a hematoma?? Are you sure your surgeon is a boarded Plastic Surgeon???

Gustavo E. Galante, MD · Answer

There is a risk of infection any time one re enters a wound, but that has to be weighed against letting a hematoma resolve on its own. The latter risks getting a capsular contracture as you mentioned. If the wound continues to drain, there is clearly an opening somewhere, and that could risk infection as well. It is best to follow up closely with your surgeon, as he or she is in the best position to see and evaluate the extent of the problem.

Melinda Haws, MD, FACS · Answer

While some hematomas can be treated conservatively and allowed to resolve on their own, they do put the patient at a higher risk of capsular contracture.  Personally, if a hematoma is not expanding, is small and neither I not the patient are convinced it even is a hematoma then after a prolonged discussion we together may decide to watch it knowing it may result in a capsular contracture later and later surgery.  If I know it's a hematoma and it is expanding or is just large enough that I am certain it is a collection of blood then I typically recommend evacuation and rinsing out the pocket to get rid of the old blood that leads to scar and capsule.  If I had a patient with an open wound that was draining the hematoma, then I Would recommend returning to the OR to rinse out the pocket, my concern being that if blood can run out, then bacteria can go in.  I would speak with your surgeon again or getting a second opinion.  Even if the bacteria contaminating the open wound don't lead to an infection, they will also contribute to a capsular contracture.  Again without examine you, I can't give sound medical advice.

What would happen if I chose to let my hematoma just drain? My incision has been draining for days now. Will I get CC? (photo)

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