Breast hematoma is a collection of blood within the

breast The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and sec ...

. 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, vagi ...

) and may arise due to trauma (breast injury or

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

) or due to a non-traumatic cause.

Symptoms

Symptoms may include visible discoloring (

ecchymosis A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

), breast pain, and swelling. The symptoms may be similar to those of

fibrocystic breast changes Fibrocystic breast changes is a condition of the breasts where there may be pain, breast cysts, and breast masses. The breasts may be described as "lumpy" or "doughy". Symptoms may worsen during certain parts of the menstrual cycle due to hormon ...

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 Reduction mammoplasty (also breast reduction and reduction mammaplasty) is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the wom ...

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 brea ...

, 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 have the operat ...

). More rarely, hematoma can result from

breast biopsy A breast biopsy is usually done after a suspicious lesion is discovered on either mammography or ultrasound to get tissue for pathological diagnosis. Several methods for a breast biopsy now exist. The most appropriate method of biopsy for a patien ...

. 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 sp ...

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 signs, ...

. 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 agains ...

and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast

surgical site infection Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consi ...

s. 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 congenital ...

surgery, the presence of hematoma increases the risk of developing

capsular contracture Capsular contracture is a response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics. The occurrence of capsular contr ...

., 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 reduction surgery * Augmentation mammoplasty *Mastectomy * Lumpectomy * Breast-conserving surgery, a less radical cancer surgery than mastectomy * Mastopex ...

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. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...

, A recent hematoma is usually visible in a

mammogram Mammography (also called mastography) 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, typically through d ...

. 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 Irradiation is the process by which an object is exposed to radiation. The exposure can originate from various sources, including natural sources. Most frequently the term refers to ionizing radiation, and to a level of radiation that will serve ...

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