hematoma 48 hours after gyno surgery

[jay123]

I took a shower today as its been more than 48 hours after surgery and i took my bandaids and compression vest off.  I noticed a possible hemotoma on my left chest and a bit on the right side too. It hurts when i touch it and I  have posted a picture of it. Please someone advice as to whether i should see a doctor and have it sucked out?  I contacted my surgeon but he is interstate and he said it should go away on its own and said nothing else because he was busy.Also  I have put two compression vests to make it tighter. The nurse asked me to put more pressure on the clot over the phone.  Does more compression make hematoma better?
I will appreciate any advice on this matter,
Thanks
Jay

[Litlriki]

In the single view you've shared, it looks like you may have developed a hematoma.  It does look like it's small enough in this view that it may resolve on its own, though often some aspiration is required as the hematoma liquifies over the coming weeks.  You should follow up with your surgeon, so that he can address that. 

[jay123]

Thanks for the reply Dr Rick. My surgeon is from a different state and the next earliest consul he has is in two months. I really don't want this hemmotoma to turn into a deep scar eventually. How soon would you suggest that I go to a regular GP and have it aspirated?  today is day 3 post op. Thanks in advance

[Dr. Elliot Jacobs]

Yes, it does look like a hematoma.  Truth be told, hematomas are like an iceberg -- there is  more to it than meets the eye.

Yes, you can wait til it liquifies -- usually around ten days or so -- but you may have trouble finding a GP to aspirate it -- that is not their line of work and moreover, many docs don't like to treat other doc's problems.  And the more time it sits under the skin, the more you will develop scar tissue.

I have a different philosophy about hematomas.  I like to drain them surgically as soon as it is recognized -- and you would be surprised as to how much blood can accumulate. Usually, the bleeding vessel has stopped -- but to be safe, I always put in a drain for a day or two.  The entire procedure takes 15 minutes -- but it is well worthwhile.

Using this method, my patients heal quickly and by a few weeks post op, one cannot tell which side had the hematoma.

If a hematoma is not drained at all or drained poorly by aspiration, there is a good chance that there will be a lot of diffuse car tissue on the chest resulting in a visible size difference. This is oftentimes difficult to correct because you cannot suction scar tissue and even cortisone has its limitations.

My recommendations to you would be to either make the journey back to your surgeon -- who should take responsibility for this complication -- or find a plastic surgeon in your area who would undertake either frequent aspiration or consider a surgical drainage procedure.

Good luck.  Sorry to be the bearer of such tidings.

Dr Jacobs

[jay123]

I really appreciate your timely reply.   I want to thank all you to take time off your busy schedule and reply the questions, It helps us alot.  I made a mistake of going to surgeon not certified by society of plastic surgeons. My surgeon is a dermatologist and he  doesn't seem like he wants to help at all. I have written my entire post surgery experience on the australia/newzealand forum.

I feel that i am might end up spending more money going to him and spending in traveling expenses, I can rather have it taken care of by some other suregon who is more qualified and certified  in sydney. The most my surgeon will do is ask his nurse in sydney to take care of it who is clearly not experienced or qualified enough to do these things. But at this stage when i sent pics via email both the nurses and surgeon looking at the pictures deny that its a hematoma and say its just a bruise.

Would you recommend any certified surgeon in sydney new south wales, australia?  Thanks

[Dr. Elliot Jacobs]

Sorry, but it makes my blood boil to think that a dermatologist, who has no formal training in surgery, would attempt a gynecomastia operation.  This operation, if done right, must be done by an experienced surgeon.

One of the cardinal mandates of a surgeon is that one should not only know how to operate, but also be capable of taking care of any post-surgical complications.  This is sadly lacking in this situation.

Best recommendation is to find an experienced plastic surgeon in Sydney to help you.

Good luck!

Dr Jacobs

[Litlriki]

It can be challenging to find a qualified plastic surgeon who has interest in "cosmetic" procedures in Australia, though it's easier to find them now as compared to the past.  But you may have to search around a little to find someone who is willing to manage a problem created by another practitioner.  But take the time to find someone, rather than going back to a non-surgeon (including your GP), who is likely not familiar with managing the sorts of problem you're having.  A general surgeon might be able to help with serial aspiration of the hematoma, but if you need surgical intervention, a plastic surgeon would be preferable. 

[DrPensler]

I would contact your surgeon. I cannot determine from the photo if you have a hematoma or postoperative bruising. Every patient has some degree of bruising after surgery some more than others. A hematoma is a collection of blood after surgery.Minimal hematomas resorb on their own while more extensive collections are aided by drainage which can be as simple as placing a needle into the area which is typically numb after the surgery and aspirating fluid. In more extensive hematoma  cases using the old incision for placement of a tube to drain the area is best.
I would stress contact your surgeon first not a message board.I often will have a patient forward a photo and we can "go from there". At this point your surgeon knows what happened during the surgery,specifically the amount of bleeding which would allow him to comment on the expectation of the degree of bruising at 48 hours.