A breast hematoma is a localized collection of blood that pools outside of the blood vessels, forming within the breast tissue itself. This condition arises from internal bleeding, creating a mass that can be felt or seen beneath the skin. While they are usually a benign finding, they must still be evaluated by a medical professional to rule out other, more concerning causes of a breast mass.
What Exactly is a Breast Hematoma?
A breast hematoma is essentially an internal bruise, where the injury to a blood vessel causes blood to leak into the surrounding adipose and glandular tissue. This pooling of blood, which often clots, manifests physically as a lump that can feel firm, spongy, or tender to the touch, depending on its age and size. The immediate signs of this process often include pain, swelling, and a palpable mass at the site of the bleeding.
The visual signs of a hematoma are similar to those of a skin bruise, displaying a discoloration known as ecchymosis that can range from dark purple or red to green and yellow as the blood is broken down by the body over time. Swelling can also change the contour or size of the affected breast, sometimes leading to noticeable asymmetry. The mass of the hematoma can sometimes exert enough pressure to cause the overlying skin to pucker or dimple.
The underlying physiological process involves the body’s natural response to trauma, where the escaping blood coagulates and forms a clot to stop the bleeding. Immune cells then begin the process of breaking down and reabsorbing the clotted blood and cellular debris. This reabsorption process is what causes the characteristic color changes, as the hemoglobin from the red blood cells is metabolized. The feeling of a distinct lump is caused by the physical presence of this clotted collection within the breast parenchyma.
Common Causes and Contributing Factors
The primary cause of a breast hematoma is trauma that results in damage to the blood vessels within the breast tissue. This can stem from blunt force injury, such as a sports accident, a fall, or the pressure from a seatbelt during a car crash. The force disrupts the vascular network, leading to hemorrhage and the subsequent collection of blood.
The second major category of causes is medical intervention, where a hematoma can develop as a complication following various procedures. Minimally invasive procedures like breast biopsies carry a risk of hematoma formation. More extensive operations, including breast augmentation, reduction surgery, or lumpectomies, also carry the risk of post-operative bleeding.
Certain secondary factors can significantly increase a person’s risk of developing a hematoma after an injury or procedure. Individuals who are taking blood-thinning medications, such as anticoagulants, are more susceptible to prolonged bleeding and blood pooling. Underlying clotting disorders, known as coagulopathies, also impair the body’s ability to stop internal bleeding effectively, contributing to the formation of a hematomas.
How Doctors Confirm the Diagnosis
Diagnosing a breast hematoma begins with a thorough clinical examination and a detailed review of the patient’s history. The physician will look for signs of bruising, swelling, or a palpable lump, noting its size, shape, and tenderness. A history of recent trauma, a fall, or a surgical procedure is a strong indication that the mass may be a hematoma.
Imaging tests are then used to confirm the presence of clotted blood and to assess the extent of the collection. A breast ultrasound is a primary tool, as it can visualize the internal structure of the mass and determine if it is a solid lump or a fluid-filled collection. On ultrasound, a hematoma’s appearance can vary, but it often presents as a fluid collection or a solid-looking nodule, depending on how long the blood has been clotting.
Mammography may also be used, particularly in women over 30, but a hematoma can be challenging to interpret on these images. The clotted blood may look like a patch of increased density, which can sometimes be mistaken for an area of concern. The purpose of the imaging is primarily to differentiate the fluid-filled hematoma from a solid mass, like a tumor, or a simple cyst.
Treatment Options and Expected Resolution
The treatment approach for a breast hematoma is typically conservative, as the majority of these blood collections resolve on their own through the body’s natural reabsorption process. For small, asymptomatic hematomas, the standard management involves watchful waiting and close monitoring. Conservative measures often include the application of cold compresses and the use of over-the-counter pain medications, such as acetaminophen, to manage discomfort and swelling.
Intervention becomes necessary when the hematoma is particularly large, causes persistent or significant pain, or shows signs of infection. A large, rapidly expanding hematoma may also compromise the healing of a surgical site or lead to poor cosmetic outcomes. In these cases, a procedure called aspiration may be performed, using a needle under ultrasound guidance to drain the accumulated blood and alleviate pressure.
If the hematoma is very large, actively bleeding, or cannot be fully drained by aspiration, surgical evacuation may be required to remove the blood clots and stop the source of the bleeding. The expected timeline for resolution varies; most small hematomas disappear within four to six weeks, though larger ones can take several months. As the hematoma resolves, the area may become fibrotic, leaving behind scar tissue that can be detected on future imaging. In some cases, the healing process can result in fat necrosis or the formation of benign calcifications, which are long-term consequences of the initial injury.