A breast hematoma is a localized collection of blood that accumulates within the breast tissue. It forms when blood vessels are damaged, leading to internal bleeding that pools outside the vessels, similar to a bruise elsewhere on the body. These collections of blood can range in size and may present as a palpable lump or an area of discoloration. Many breast hematomas are temporary and resolve naturally.
Understanding Breast Hematomas
Breast hematomas often result from trauma, such as a direct injury or a car collision. They also commonly occur following breast surgeries, including biopsies, lumpectomies, augmentation, or reduction, with formation sometimes appearing within hours or days post-procedure. Certain medications, like blood thinners, can increase the likelihood of developing a hematoma, even from minor trauma, by interfering with the body’s natural clotting process.
Symptoms include visible bruising or discoloration, breast pain, and swelling. The affected area might feel tender, and a distinct lump or mass can be present. The discoloration often changes over time, evolving from dark purple or red to green, then yellow, as the blood is reabsorbed by the body.
Criteria for a Large Hematoma
Defining a “large” breast hematoma involves more than just a specific measurement; it encompasses a combination of factors related to its clinical impact and potential for complications. While there isn’t a universal numerical standard, a hematoma is often considered significant if it causes substantial discomfort, visible changes, or poses a higher risk of adverse outcomes.
A hematoma may be deemed large if it leads to severe or increasing pain that is not alleviated by common pain medications, or if it causes noticeable distortion of the breast shape. Rapid growth of the lump or bruise can also indicate a larger or actively bleeding hematoma. Such a collection of blood can compress surrounding breast tissues, potentially affecting blood flow or nerve function, leading to symptoms like numbness or tingling.
The potential for complications often dictates whether a hematoma is considered large. Significant hematomas can interfere with wound healing after surgery, increasing the risk of infection by creating an environment conducive to bacterial growth. They may also prolong recovery, potentially leading to long-term issues such as fat necrosis, scar tissue formation, or the development of a seroma, which is another fluid collection. Following breast implant surgery, a large hematoma can increase the risk of capsular contracture, where scar tissue tightens around the implant. Very large hematomas can lead to significant blood loss, potentially resulting in hypovolemic shock, particularly in vulnerable individuals.
Recognizing Serious Symptoms
Certain symptoms associated with a breast hematoma warrant prompt medical evaluation, as they may indicate a complication or a need for intervention. Increasing pain or tenderness that is not relieved by over-the-counter medication suggests ongoing pressure or inflammation within the breast. A lump or bruise that is rapidly growing in size is also a concerning sign, as it may signal continued bleeding or expansion of the hematoma.
Signs of infection warrant monitoring. These include worsening redness, warmth, or tenderness of the breast, especially if accompanied by a fever or the presence of pus discharge or red streaks on the skin. Persistent or worsening swelling, even without other infection signs, can indicate a hematoma that is not resolving or is continuing to expand. Any new or unusual lumps appearing after a breast injury or surgery should be assessed by a healthcare professional to rule out other issues.
Diagnosis and Treatment Approaches
Diagnosing a breast hematoma typically begins with a physical examination of the breast, where a healthcare provider assesses bruising, swelling, and any palpable lumps. A detailed medical history, including any recent trauma, surgical procedures, or medication use, helps establish the context for the hematoma. Imaging techniques are often used to confirm the diagnosis, determine the hematoma’s size and location, and differentiate it from other breast conditions. Ultrasound is a common imaging tool that can visualize the fluid collection and assess its characteristics. Mammograms may also show a hematoma, though a large one can sometimes resemble other tissue changes, requiring careful interpretation.
Treatment approaches for breast hematomas vary depending on their size, symptoms, and potential for complications. Smaller hematomas causing minimal discomfort often resolve on their own as the body naturally reabsorbs the blood. In these cases, conservative management with cold compresses, pain relief, and observation is usually sufficient.
For larger or symptomatic hematomas, or those not resolving, medical intervention may be necessary. This can involve aspiration, where a needle is used to drain the accumulated blood, which helps alleviate pressure and pain. In rare instances, particularly for very large hematomas, those that are actively bleeding, or those that do not respond to aspiration, surgical evacuation may be performed to thoroughly remove the blood clots and address any bleeding vessels. The choice of treatment is tailored to the individual’s specific situation to promote healing and prevent further issues.