Breast hematoma is a collection of blood within the

breast The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryology, embryological tissues. The relative size and development of the breasts is ...

. It arises from internal bleeding (

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...

) and may arise due to trauma (breast injury or

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

) or due to a non-traumatic cause.

Symptoms

Symptoms may include visible discoloring ( ecchymosis), breast pain, and swelling. The symptoms may be similar to those of fibrocystic breast changes.

Causes

A breast hematoma may appear due to direct trauma to the breast, for example from a sports injury or a road accident, for example a vehicle collision in which a seat belt injury occurs. Hematoma can also be a consequence of breast surgery, usually due to post-operative bleeding. Bleeding may occur shortly after the intervention or a number of days later and can occur for cosmetic surgery (for example breast reduction or breast enhancement) and for non-cosmetic surgery (for example lymph node removal,

lumpectomy Lumpectomy (sometimes known as a tylectomy, partial mastectomy, breast segmental resection or breast wide local excision) is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or bre ...

, or

mastectomy Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer choose to have ...

). More rarely, hematoma can result from breast biopsy. Rarely, a breast hematoma can also occur spontaneously due to a rupture of blood vessels in the breast, especially in persons with

coagulopathy Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding ( bleeding diathesis), which may occur s ...

or after long-term use of blood-thinning drugs such as aspirin or ibuprofen.

Pathophysiology

Small breast hematomas often resolve on their own within several days or weeks by means of reabsorption of the blood. Larger hematomas are more likely to lead to inflammation or fibrosis. Breast hematomas can sometimes lead to skin discoloration, inflammation, or fever. When a hematoma resolves, it may become fibrotic, leaving behind scar tissue. A resolving hematoma may liquify to form a

seroma A seroma is a pocket of clear serous fluid (filtered blood plasma). They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical sign ...

. Post-surgical breast hematomas can also impede

wound healing Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier again ...

and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast surgical site infections. There is preliminary evidence that, after

breast implant A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenita ...

surgery, the presence of hematoma increases the risk of developing capsular contracture., see sections "Results" and "Conclusions" In mammography screening, scar tissue resulting from a breast hematoma can easily be confused with tumor tissue, especially in the first years following surgery. Ultimately, fat necrosis may occur in the concerned region of the breast.

Diagnosis

When there is post-operative swelling after

breast surgery Breast surgery is a form of surgery performed on the breast. Types Types include: * Breast augmentation * Breast reduction * Breast-conserving surgery, a less radical cancer surgery than mastectomy * Lumpectomy * Mastectomy * Mastopexy, or brea ...

or core needle biopsy, a breast ultrasound examination may be indicated in order to differentiate between a hematoma and other possible post-surgical complications such as

abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

, A recent hematoma is usually visible in a

mammogram Mammography (also called mastography; DICOM modality: MG) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer ...

. and it also shows typical signal intensities on MR imaging. If a differentiation from breast cancer is necessary, a hematoma biopsy may be indicated. A careful consideration of the case history is important for the diagnosis of a breast hematoma.

Treatment

Small breast hematomas that cause no discomfort often require merely clinical observation, with ultrasound being used to monitor the resolution of the hematoma. Large breast hematomas, or those that are not becoming smaller or that are causing discomfort, usually require drainage. Also hematomas that occur after surgery for excision of a malignant tumor are drained, because a hematoma to which irradiation is applied is unlikely to ever resolve. A recent hematoma can be drained by means of needle aspiration or (rarely) open surgical drainage.

References

External links

{{Diseases of the breast Breast diseases