Managing Hematoma After Minimally Invasive Breast Surgery: What to Know

Hematoma issues in minimally invasive breast surgery?

I would like to inquire about the findings of fibrocystic adenomas on both sides.
The doctor on the right side mentioned that the shape is more irregular and recommended a biopsy.
The biopsy results showed it to be benign, and follow-up monitoring was advised.
However, it has slightly increased in size afterward, and I am unsure if this is due to my menstrual cycle or another reason.
I opted for minimally invasive excision.
It has been 11 days since the breast minimally invasive surgery.
On the day of the surgery, the compression bandage was not applied tightly.
I returned to the ward at 11:30, and the doctor said the bandage could be removed at 3:00 PM.
After removing the bandage, I noticed swelling on the side where the surgery was performed.
The nurse came to check and rewrapped the bandage, advising me to apply pressure to stop the bleeding and to use ice packs.
The next day, the doctor checked and noted that the swelling was not as significant as the previous day, so I was discharged to go home.
The nurse instructed me to continue icing at home, and the bandage could be removed two days after discharge.
After returning home, I forgot that the bandage could be removed and kept it on for about five more days.
Later, I noticed that although the swelling had decreased, there were severe bruises, and the bruised areas felt hard when touched.
Should I consider another surgery to remove the hematoma? Before my follow-up appointment, should I apply ice or heat?

Chen's, 30~39 year old female. Ask Date: 2023/04/03

Dr. Tang Yuxiong reply Surgery

Hello Ms.
Chen, regarding the hematoma, generally those smaller than 3 centimeters will reabsorb on their own, typically within 2 to 3 months.
It is recommended to apply warm compresses during this period and to have regular follow-up appointments.
If there is persistent swelling or pain, please return for an earlier consultation.

Reply Date: 2023/04/03

More Info

Managing hematoma after minimally invasive breast surgery is an important aspect of postoperative care that can significantly affect recovery. Based on your description, it seems you are experiencing some typical postoperative symptoms, including swelling, bruising, and localized hardness in the area where the surgery was performed.
Firstly, it is essential to understand that hematomas, which are collections of blood outside of blood vessels, can occur after any surgical procedure, including minimally invasive breast surgeries. They can result from bleeding during or after the surgery and may be influenced by factors such as the size of the tumor removed, the surgical technique used, and individual healing responses. In your case, the presence of a hematoma is not uncommon, especially given that the surgery involved the removal of a fibroepithelial lesion, which can be vascular.

The fact that you have noticed a significant bruise and a hard lump in the area indicates that there may still be some residual hematoma. It is crucial to monitor the symptoms closely. If the hardness persists or increases, or if you experience increased pain, redness, or warmth in the area, it may indicate that the hematoma is not resolving as expected. In such cases, it is advisable to consult your surgeon for an evaluation. They may recommend imaging studies, such as an ultrasound, to assess the hematoma's size and characteristics, and determine if further intervention, such as drainage, is necessary.

Regarding your question about whether to apply ice or heat, the general recommendation in the first few days after surgery is to use ice packs to reduce swelling and numb the area, which can help alleviate pain. Ice should be applied intermittently (15-20 minutes at a time) and should not be placed directly on the skin to avoid frostbite. After the initial swelling has decreased, typically after the first few days, heat may be applied to promote blood flow and healing. However, since you are still experiencing significant bruising and hardness, it may be best to continue with ice therapy until the area feels softer and the swelling diminishes further.

In terms of your follow-up care, it is essential to adhere to the schedule provided by your healthcare provider. If your next appointment is approaching, it is a good idea to keep it, as your surgeon will be able to assess the healing process and provide guidance on whether any further treatment is necessary. If you feel uncertain or anxious about your symptoms before your scheduled appointment, do not hesitate to reach out to your healthcare provider for advice. They may be able to provide reassurance or recommend an earlier evaluation if needed.

In summary, while some degree of swelling and bruising is expected after minimally invasive breast surgery, persistent hardness and significant discomfort warrant further evaluation. Continue to ice the area, monitor your symptoms, and maintain communication with your healthcare provider to ensure a smooth recovery.

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