How can you tell if you have swelling vs a hematoma or seroma?

[dadz]

I'm not worried about my longterm results as I'm only 3 days post-op, but my left side is significantly larger than my right and there is a considerable amount of bruising on that side as well. I don't feel any hard tissue and am not draining, so is it reasonable to assume that this is just residual swelling and it will go away? My surgeon seems almost dismissive and doesn't want to drain it insisting that this is purely swelling. I have absolutely no bruising on my right side and it looks fine even though it is surely swollen to some degree as well. I can post a picture tomorrow morning after I remove my vest to shower if necessary. I appreciate any advice! I'm going to see my doc soon too so I'm going to ask for him to aspirate it one more time.

[Dr. Elliot Jacobs]

It sure sounds suspicious -- but please post several photos for us.

Dr Jacobs

[dadz]

here is a link to the album

http://s1178.photobucket.com/albums/x372/livingwithgyne/






the right side has absolutely no bruising and is definitely a decent amount smaller than the left.





There are a few more pictures in the album.


Is there a way to feel whether or not there is a seroma/hematoma or just normal fluid due to swelling? He still did not want to aspirate it insisting that it will go down on its own. I'm sure it will go down on its own over time, but I can't help but feel suspicious about its appearance.

[Dr. Elliot Jacobs]

The photos are not ideal -- it would best to have another person take photos of the entire chest with both arms at your sides, so we can see the difference between the two sides.

However, there does seem to be a significant difference between the two sides -- and that might indicate some fluid/blood accumulation. 

Best to discuss this with your surgeon.

Dr Jacobs

[dadz]

Doc, sorry I haven't been able to get better pictures. As far as size is concerned, things haven't changed much, but the feeling certainly has. My surgeon insists it is normal healing, but the left side is simply bigger, more pointy, and much harder. I feel a lot of hard tissue (not gland) and am not sure if this is scarring. He doesn't recommend massaging or anything other than wearing my compression vest. Should I be less paranoid and give it time to see if it subsides? The right side has a couple of little hard areas, but the entire left side of my chest is quite hard. I could basically grab something that feels like a 2x3" block of hard tissue. Any input would be appreciated. I just don't know what I'm dealing with here.

[dadz]

Any input? Is it normal to have what I believe is scar tissue that size? The left side of my chest is probably about the same size it was pre-op. I know it's not gland or fat, but the contour looks exactly the same and the density of what I think is scar tissue is bothering me. My surgeon would just keep insisting it is normal swelling and not due to fluid accumulation or blood accumulation even though it happened the night of the surgery.

[Dr. Elliot Jacobs]

From your history and description, it sounds like there may have been a blood accumulation.  The hardness that you describe is typical.  At this point there may be nothing that can be done other than to be patient and allow Mother Nature to heal it. Sometimes it may be possible to aspirate some liquid with a syringe -- usually starting at about 10-12 days after surgery.  You should ask your surgeon about this possibility.

Dr Jacobs

[dadz]

Thanks for the reply Dr. Jacobs. That had basically been my hunch from the beginning, but my doctor for whatever reason refused to aspirate any liquid from the onset of the symptoms. My next followup with him isn't until the 16th of December so maybe I'll just ride it out until then and see what I'm working with. I'm happy with the right side and am confident the left would have looked the same at this point had he not been against aspirating it earlier on. Hopefully it does go down and clear up with time. For the time being, this is equally, if not more psychologically exhausting than having a case of gyne with the added negative of being out thousands of dollars. Will update here with any news. Thanks again for the reply!

[dadz]

I figured I would just update here in case anybody ever had a similar issue and searches it in the future. I actually started developing a little pain on the left side, but on a 1-10 scale, I would have rated it at 3. After not seeing any progress, I decided to start wearing the chest binder again around the clock. I've been wearing my compression vest, but due to numbness in the area, I couldn't really tell you how "tight" it was. Initially, the doctor had me remove the binder at the 1 week mark and now after 2 days of wearing the binder again, the size of the swelling and left side of my chest has definitely gone down. I'm not sure if it would get worse if I stopped wearing the binder, but I'm just going to continue wearing it for the next week or so. My doctor's orders are to wear this vest until Monday and then only 12 hours a day after that, but I will be wearing it 24hrs until the end of the 4th week as well. Will update here with any progress or news.