post surgery hematoma

[UKBound]

Hello all,

I had surgery last Thursday to remove the gynecomastia that has plagued me since I was a teenager. A few days later when checking the results I was rather horrified to find that the two sides were drastically different, on one side there was no visible bruising (well a little yellow, thats all) and on the other, horrific swelling, purple lines/bruises. I spoke to the surgeon and the team and was advised this was a hematoma, I had it looked at and was advised that although the swelling was fairly significant the best option was to wait for it to liquefy and then extract it with a syringe. The hematoma is mainly soft and jelly like, although there seems to be the odd harder patch. They attempted to suck some out on day 4 but found that due to it's consistency (jelly like), we'd have to wait. While everyone there has been great, and have done their best to put my mind at ease I still can't help but feel a little worried. The consensus there was that, while they could suck it all out with a similar procedure as the first time around, there's risk of infection, I'd have to go through another general again, and there's potential for it to start bleeding again.

Just a few things that I'd like another opinion on - is waiting the best option?  It's going to be a bloody anxious 7-10 days waiting for this stuff to liquefy. I'd hate to go through surgery again, bit do it in a heartbeat if this is the right option. Secondly, will the blood/ horrific purple coloured skin I have at the moment clear? Obviously purple bruises dissapear, but I've never seen bruises like these! How long does that usually take? I'm happy to send a photo or two to anyone interested and better able to offer advice having seen them.

Look forward to hearing from you!

[DrPensler]

Hematomas certainly occur following gynecomastia surgery. Any surgeon  who claims they have not had any hematomas  either does not perform much surgery or is not being honest.Each hematoma is a bit different ,some require drainage surgically ,some can be aspirated ( removed with a needle ), some resolve on their own. Its terribly frustrating for the patient and the surgeon,however is not typically a life threatening situation unless there is an underlying  medical problem . The resolution of a hematoma  is typically excellent.
Hang in there.
Jay Pensler,MD

[Dr. Elliot Jacobs]

Agree with Dr. Pensler.  There is no surgeon on this planet who has not had a hematoma.  It can occur very soon after surgery or even a week or so later.  The use of drains will not -- I repeat, will not -- prevent a hematoma.  I have observed hematomas in patients with drains in place!

How to recognize one?  If both sides were initially flat and even -- and then one side is much more swollen, purple and painful, then you probably have a problem.

What to do if one occurs?  Immediately call and go to see your surgeon.  If it is small, then one may opt to watch it -- or attempt to drain it when it liquifies  (about 4-7 days later).  If it is large, I, for one, prefer to re-operate as soon as feasible.  We can then physically remove all the clotted blood.  Usually whatever vessel was bleeding has most often stopped bleeding.  So it is basically a clean-up procedure to remove the large pool of blood and hasten the healing.  Assuming this is done in a proper operating room, there is no major added risk of infection.  Oftentimes, placing a drain will then help to remove any residual liquifying blood over the next several days.

The result is faster and better healing for the patient.

Dr Jacobs

[Litlriki]

Both Dr. Pensler and Dr. Jacobs have answered most of your questions.  But to give you a little more relief (hopefully), since you're being observed and undergoing serial aspiration of the liquifying hematoma, this is something that happens on occasion, and it works very well for small, delayed hematomas.  i have found that most of my patients who have had this problem are just about normal by 6 - 8 weeks after surgery, other than perhaps a little more swelling on the side of the hematoma.  It takes some patience on your part, but the long term outcome should be the same.

Rick Silverman

[UKBound]

Thanks guys for your advice, I really appreciate you taking the time out of your day to offer your comforting advice.

I went in last week and had a huge amount of the 'gunk' removed, firstly by needle aspiration and secondly with a small incision under my nipple (with a local anaesthetic). I must say this is one of the most horrific things I've ever seen (or caught a glimpse of!). I must really hand it to you guys, that's the stuff horror movies are made of. It was raspberry jam being squeezed out of my chest. I would estimate 200-300ml's of the stuff. A serious amount. The immediate result was great, chest was a lot flatter with just a few craters around the edges which are extremely hard to touch. I'm hoping these are still clots rather than scars, but I'm a little doubtful. My chest has also filled out a little bit more, I'm hoping it's just more of the hard stuff liquefying as my nipples very soft to touch, and hard around the edges further out.

I didn't have drains, I was a little dissapointed when I read that it greatly reduces the chances of it happening. In saying that, the surgeon said this is the first one he has seen in about 3 years, and this is the method he has always used. Just bad luck I guess.

I'm inclined to do a lot of reading which is probably detrimental to my mental well being, I've now read all about seroma's & pseudobursa's and worry this is what I have or is developing into.

I hope I don't sound like I'm being far too impatient, I'm trying to be realistic and accepting of the fact that these things do take time. I'm 28 now and as someone that has suffered for 15+ years whats a few weeks/months? You just want to feel like the right things is happening, you place so much trust in one persons opinion its hard not to feel like you should be at least checking what is happening is the correct course of action (due diligence I guess).

My surgeons optimistic so I should be too I guess!

2 weeks in, I shouldn't be worried at all by the hard lumps? These should soften up over the next few weeks or so?

[Litlriki]

It does take a while for the lumps to resolve, and following a hematoma, that takes even longer.  You may feel some lumps around the periphery of the "gland resection," where some hematoma may be in the liposuction tunnels, rather than in the larger cavity from where the majority of the hematoma was drained.  Massage will help this to resolve, and you may need additional aspiration of fluid in the space. 

You'll hear it more than once over the coming months: be patient.

RS