A hematoma is a collection of blood inside the body.
With breast augmentation
the build-up of blood pooling is within the breast itself around the
implant and or the incision from a broken blood vessel. Usually this
symptom occurs soon after the actual surgery; however you can have a
hematoma occur within several weeks post operative.
Post operative bleeding is
caused by a number of different reasons and sometimes the actual reason
on why it has happened remains unknown. During the surgery before the
incision is closed, surgeons are careful to control any bleeding
vessels. These bleeding vessels are usually cauterized with an
electrical current which forms a clot. During the healing stage of
recovery, the clot may fall off and allow the blood vessel to start
To help reduce the chances
of a hematoma occurring after breast surgery or any other cosmetic
surgery procedure, avoid taking any blood thinners at least two to three
weeks prior to and after your surgery. Blood thinning medication
includes all drugs that contain aspirin, ibuprofen, Vitamin E, and
Garlic supplements. Also, refrain from drinking alcohol for a period of
time as well, as this can also thin the blood.
Patients can sometimes
have a certain bleeding disorder, with a reduced ability to clot
properly. These causes can be unknown.
surgeon before your surgery if you have any of the following:
Hematomas may develop
slowly without symptoms or rapidly with symptoms. The smaller a hematoma
the better it is for the patient as these usually resolve without any
kind of intervention; however large hematomas usually require some kind
of medical or surgical care. Draining the hematoma aids in proper
healing, and although there might be a tiny scar from the actual
draining, most of these heal without any kind of scarring.
Symptoms of a
Bruising and or discoloration
Normally hematomas arise within
the first week following surgery. If a hematoma is present almost immediately
after surgery, then more than likely a blood vessel has been broken. There are
some hematomas which can occur up to couple weeks after surgery, and this is in
correlation to the natural phase of clot lysis. During this time, your body
naturally reabsorbs blood clots which were formed during surgery. If you are
exerting yourself physically during this time, then the risk of hematoma
A hematoma is a collection
of blood in the surgical site which sometimes requires some surgical
intervention, including re-opening the wounds, evacuating the blood
clot, and try to find the source of the bleeding vessel if one can be
If the hematoma gets too
large; it can compress the surrounding tissue in which will prevent
oxygen from getting to the skin. This can cause the skin to possibly
die. If this happens, the patient will need to return to the surgical
room to have the bleeding stopped, the excess blood removed and finally
a drain placed to prevent any further complications.
Sometimes the actual
surgical procedure is done with a hematoma; the active bleeding can
sometimes just stop on its own.
The risk of getting a
hematoma is very low, less than 2 percent, however for the patients who
have taken aspirin or ibuprofen before surgery, the risk is higher. It
is also higher in those patients who return to a physically demanding
occupation or resume exercise too soon.
To reduce your chances of
getting a hematoma, it is wise not to increase your heart rate during
your recovery for a period of four to six weeks. Limiting the exertion
with exercising will help reduce this risk. Having a
evaluation by your plastic surgeon before surgery with help with telling
your physician underlying problems you might have. Managing your blood
pressure is very important, and by having this controlled before
surgery, patients can significantly lower their risk for blood clots.
Hematomas are normally
rare, and it normally is unusual to have post operative bleeding. But if
this occurs, everything will be done to resolve the problem. By
following your Plastic Surgeon’s Pre Operative Instructions will help
tremendously, along with making sure you are forthcoming with any
problems that might be related to this complication.
A seroma is an
accumulation of fluid in the surgical area, usually occurring right
after surgery; it can also occur after an injury to the area. A seroma
can be drained and usually resolve within a few weeks; however with a
smaller seroma - the body usually has no problem absorbing these. Most
plastic surgeons will drain the fluid with a syringe and needle using a
technique known as aspiration.
Seromas are one of the
most difficult complications of plastic surgery. They can occur in the
presence of a foreign body (such as a breast implant) or in the absence
of one (such as after an
The more extensive a
surgical procedure is; the more likely a seroma could possibly occur.
The larger the seroma, the longer it will take to resolve to resolve;
and also the more likely the fluid could be complicated by a secondary
infection. Diagnosis of a seroma can include the patient having an
In problematic cases, explore
and remove the seroma cavity
Possible removal of the breast
The critical issue is the
fact that this fluid inside the seroma is a good media for bacterial
growth and if infection occurs an abscess will be formed. Surgical
drainage and a course of antibiotics will help prevent an infection from
If your surgeon has
suggested a drain to be left in place to help drain the seroma, it
depends on the individual patient needs on how long it will stay in
place. Drains can stay in from a day to several weeks, depending on how
much fluid is being accumulated.
The benefit of a drain is
that it helps to avoid a collection of blood (hematoma) or fluid (seroma).
It also will pull the skin against the underling tissue and promote
closure of a space.
Untreated seromas can lead
to a pseudo-bursa formation, in which a layer of scar tissue (the
pseudo-bursa, or fake sac) forms around the fluid. In breast
augmentation, a seroma of the breast can lead to capsular contracture.
Exercise increases your
heart rate and blood pressure which lead to increased swelling. Exercise
also causes friction of your tissues from all the movement which also
leads to more fluid production. Refraining from getting your heart rate
too high will help you resolve a seroma faster.
Removing a seroma without
rupturing the breast implant can be difficult, so if the volume of the
seroma is small, the fluid is sometimes left to reabsorb on its own.
Occasionally, the fluid volume is too great and causes symptoms and must
be drained. Most plastic surgeons will drain the fluid with a syringe
and needle using a technique known as aspiration. Seromas around a
breast implant are very important to drain, because if the fluid becomes
infected, the patient could possibly lose their implant for a period of
Draining a seroma with a
breast implant present is often harder to deal with because of the issue
of the implant being compromised by the needle used to aspirate.
Aspiration is a minor drainage technique, requiring a needle and syringe
to withdraw the collection of fluids. The greatest risk associated with
aspiration is possibly the puncturing of the implant in which it could
cause leakage and or
Some surgeons might opt
for ultrasound-guided aspiration in the hopes of having a clearer
picture on where the implant is situated so that the risk of puncturing
increase the risks of infecting the seroma and needing to remove the
breast implant, and sometimes, additional corrective surgery is
required. A surgical drain is inserted into the breast tissue to
discourage further fluid collection. Inserting a drain is a minor
procedure. However, some sort of anesthetic or light sedation is given
to the patient before the procedure, so that they are comfortable.
A seroma is a collection
of fluid that continues to accumulate. Seroma refers to a collection of
serous fluid (the pale yellow straw colored fluid that is produced by
lymph vessels and by the tissues that lie under the skin). The formation
of these fluid collections is facilitated by the disruption of
lymphatics and blood vessels as well as by the creation of large
potential voids beneath the skin.
Post operative problems
due to seroma formation in breast reduction or reconstruction:
Drains are standard
breast reconstruction surgery, as it is normal for some
fluid to collect in the area. Drainage tubes are put in place to help
with any excess fluid, and this helps with keeping the complication of a seroma from happening. However, sometimes a hematoma or a seroma will
develop under the incision and most of the time the body will absorb
these naturally. But if these seromas or hematomas are large they are
removed by aspiration using a small needle and a syringe, pressure
applied and possibly have antibiotics injected to stop the collection of
fluid. The purpose of the antibiotics (such as tetracycline) is
essentially to stick the tissues together to help prevent the fluid from
This is a common
complication after a mastectomy and thought to be caused by the fact
that the mastectomy surgical procedure left a lot of “empty space” under
the skin where the breast tissue use to be. The walls around this empty
space are raw and tend to ooze serous fluid. This causes it to gather up
in the space beneath the wound. The fact that the walls of the empty
space are inflamed seems to trigger the seroma fluid.
implants - most
surgeons like to wait on any aggressive treatment with the seroma,
simply because of the fact the needle into the seroma could potentially
rupturing the implants. However, reconstruction with patients who have
TRAM flap, surgeons are more pro-active with aspirating seromas
simply because there is no implant there to potentially rupture.
The latissimus dorsi flap
- is a
common option in reconstruction of the breast for a breast cancer
patient. Donor-site seroma is a commonly described post operative
complication of the
latissimus dorsi flap. Increased age, obesity, and
invasive breast surgery are risk factors for donor-site seroma formation
after breast reconstruction with the latissimus dorsi flap.
Seromas are a know
complication of procedures such as
tummy tucks. A seroma is a collection
of fluid that occurs after a procedure such as an abdominoplasty. With
abdominoplasty a large cavity is created from removal of excess skin and
fat. Sometimes liposuction is performed with this procedure. The fluid
collects from small lymphatic’s that are cut and this fluid may persist
even after drain removal. If the seroma is large, aspirations might be
done as an office procedure. Drains are often placed to help reduce this
lymphatic fluid. With abdominoplasty the overall incidence can vary from
5 – 10 percent.
Early and prompt
intervention usually prevents long standing problems caused by a seroma.
Once a seroma has been diagnosed, it needs to be drained, immediately.
This normally means the insertion of drains, that are left in place long
enough to allow the fluid to come out and the overlying tissues to heal.
Liposuction of the flanks
is a common procedure done with a patient who is undergoing an abdominoplasty. Having these two procedures together does not appear to
increase the risk of seroma formation. However, patients who are
overweight or obsess present a significantly higher risk for developing
seromas post operatively than patients of normal weight.
Seroma accumulation is one
of the more common problems seen following abdominoplasty however; it
does not seem to alter the end cosmetic result. An abdominal binder or
compression garment placed on the patient after the abdominoplasty helps
facilitates fluid removal through the drains and promotes the
compression of the fluid filled soft tissues. The binder is an essential
part of post operative seroma management as it maximizes the efficacy of
the drains and promotes adherence of the soft tissue flap to the
underlying abdominal wall fascia.
Seroma and Liposuction
A hematoma that occurs
during liposuction means bleeding into a closed area under the skin. Seroma defined is a pooling or leakage of fluid (blood serum) into a
closed area beneath the skin. There have been reports of excess fluid
with the Vaser type of liposuction.
If your surgeon decides to
have the seroma drained, it is important to continue with the
compression garment and decreased activity for another 4 weeks, or else
this problem might resurface once again. A seroma is a possible adverse
side effect of a liposuction procedure.
associated with Seroma in Liposuction:
Liposuction using a large
Inadequate wound drainage
Type of lipoplasty technique
With liposuction, the
seromas are caused by the cannula used to extract the fat, as it helps
in draining fluids from the treatment area but it also makes a large
cavity within the fatty tissue. Liposuction techniques such as
Laser cause additional damage to the tissues and can create a
stronger inflammatory response from the body which will then produce
more fluid resulting in a seroma. Having a
large scale liposuction
procedure will also contribute to making seromas more likely.
To treat the seromas, a
needle is inserted and the serum is collected in a syringe. If the
seroma goes untreated in the initial stages it can take several months
to finally resolve it.