Worried About Contracture from Hematoma

I had BA done about 13 days ago. My left breast is higher, very hard, swollen, significantly bruised (suspect for a hematoma - should I request an ultrasound?). Both breasts are hypersensitive. MY PS is telling me to be patient and not to worry, yet he is having me come in to be seen every few days. I am afraid I may get CC. Is this bruising on one side normal? How long do you wait, what are the symptoms? Generally speaking, what is the process for revision (timing, cost, surgery?)

Doctor Answers 2

Ultrasound not usually needed

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Hematoma after breast augmentation is usually determined based on your physical exam. Typically if there is a hematoma, that area would feel firm or more swollen than usual, larger in size, and show discoloration or bruising visible through the skin. Keep in mind after surgery it is normal to have some degree of swelling, bruising of the skin, and even asymmetry before the implants settle (one can settle before the other). Usually bruising gets better with time and is usually gone at around 10 days. The initial swelling can give a firm feeling, but the breasts get softer as the swelling goes down. I do think undrained hematoma puts you at higher risk for capsular contracture in the future. If you have continued firmness localized to one area of one breast, with associated bruising, it does sound suggestive of hematoma. The best person to evaluate this first is your surgeon, and it is good that he is maintaining close followup. I would discuss your concerns with him, and if you feel uncomfortable with his answers you can always seek out a second opinion.

Hematomas and capsular contractures

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It is known that a hematoma that is undrained can increase the risk of a capsular contracture.  A skin bruise is not a hematoma but the extra fullness on your left side may be one.  A bilateral ultrasound to compare the "normal" side which will have some normal fluid and the left side to see how much more there is might help make the decision to drain it or watch it but your doctor knows best what to do for you so see them as often as they want.  Of course, not all hematomas become capsular contractures either.

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