11 Days After...

[RyGuy14]

Hey all, been lurking on here for a while, and thought I would post and show some good and some bad.

So a little background. I'm 20 (turning 21 in 13 days!!) and have had gyno for for about 12 years. At my worst I was over 200 pounds in middle school. I knew my chest was different, but I never considered surgery until my junior year of high school. Now I'm in the junior year of college and finally got it done (on the 6th of this month). Everything went pretty well, except about a week ago I noticed my left side getting significantly larger than my right. I had a follow up appointment on the 12th and my surgeon assured me that it was just normal postop swelling and that it should go away in 4-6 weeks. Here's my concern: my left side has gotten worse over the last 5 days, almost to the point of pain. Here's some pics. As you can see, my right side healed up very nicely (full range of motion and even one arm pushups!). However my left side is much lower and is very bruised and swollen. I can kind of feel a squishy material behind my nipple (honestly I can't even tell where my nipple is because it's so bruised). Can't tell if its fluid or something worse...

What do you guys think? I'll be out of town for the holidays and will not be back until January 3rd, so I won't be able to see my surgeon until then. Should I be worried about anything here?

[George Pope, M.D.]

It looks like you have a small hematoma on that side.  It's not really a problem as long as it doesn't continue to enlarge.  Be sure your surgeon sees these photos and gives you advice on what to do.  If it doesn't get any larger, it will eventually liquify and your body will get rid of the liquified blood.

But once again, be sure your surgeon is aware of this.
You look good, BTW.  There are no preop photos for comparison, but you should be happy with your result.

Dr. Pope, MD

[RyGuy14]

Thanks for the quick reply! Unfortunately I leave tomorrow to go home and will be unable to visit my surgeon in time. The best I could do is call him and send him these photos. I'm in the military, so I could probably have something done at my hospital at my relative's if necessary (although a little strange). Do you think this is something that I should be worried about or will it be safe to leave for 3 weeks?

If by chance the body does not absorb this, how would we go about fixing it? I've read about surgeons extracting the blood with a needle. Would that be acceptable here or would another surgery be necessary?

[George Pope, M.D.]

It looks small enough that it may resolve on its own.  It's possible to aspirate liquified blood with a large needle, but it takes 10 days or so for a clot to liquify.  You're probably OK just watching it for awhile.  There's always a (small) chance of infection when there's any type of fluid just sitting around, so be sure to look for new onset of skin redness, tenderness. Just try to get back to your surgeon as soon as you can.  A doc in another area may not want to get involved, but if it gets bigger or gets infected, you may be forced to see someone else.

Dr. Pope, MD

[Dr. Elliot Jacobs]

Agree with Dr. Pope.  A small hematoma can be observed and needle aspiration/removal performed at about 10 days or so after surgery (when the blood clot has been enzymatically degraded and has become liquified).

However, it is my opinion that most hematomas are actually larger than what appears on the surface -- think of the iceburg being larger underneath than what appears above the water surface.  Waiting for a blood clot of a decent size to absorb by itself will usually result in a large amount of scar tissue, which will ultimately result in the affected side being much larger than the other side.  Then, a revision operation would be needed -- and revising a breast with substantial amount of scarring is very difficult.

Therefore, would recommend you follow this closely and return to your surgeon if possible.  My philosophy is to go back in and evacuate any hematoma as soon as recognized.  It is usually a 15 minute procedure to remove the clot, put in a drain and sew up the nipple.  And it will do major things to help the eventual healing.

Good luck!

Dr Jacobs

[RyGuy14]

Is there anything I can do in the meantime that can help with the absorption of the blood? I can feel that it's still a little squishy but I'm also noticing there is a little firm piece of material under there too which kind of makes me think the blood has clotted. I've read that a heat pad can help break the clot and help absorb better. Any suggestions?

[George Pope, M.D.]

I recommend you leave it alone.  A heating pad could burn your skin if you have any loss of sensation early after the surgery.  Try not to worry about it - just follow up with your surgeon when you can.

Dr. Pope, MD

[RyGuy14]

Ok thank you! Hopefully it'll get better over the next few weeks!

I really appreciate everyone's help! Definitely puts me a little more at ease about this whole thing. And very educational too! Thanks!

[RyGuy14]

UPDATE:

Called my surgeon yesterday and forwarded him these new pictures. He said it is definitely a hematoma and to just leave it for now. I asked if he thought it should be aspirated, and he said with the current condition it's in, probably not as the only thing that would probably result is an infection. He did say that the hard feeling stuff is most likely the unliquified part of the hematoma and that it should go away on its own.

He said leave it for another 6 to 8 weeks, and if it doesn't go completely away to come in and have him take a look at it to discuss further options.

Here's the same pictures I sent him. He requested a full on shot, a side shot, and a comparison shot. It's been another 5 days since the last pictures.

Do you guys think this is getting better, worse, or about the same? I think it's gotten a little worse, but it's hard for me to tell because I see it every day. Only 5 days have passed, but things should be looking better now...

[George Pope, M.D.]

It actually looks better to me.  The swelling is down overall, and the discoloration is less and limited to the area around the hematoma.  It will eventually fade away, but it's going to take a number of weeks.  Since it hasn't gotten any larger, I would not aspirate it.  As he said, introducing a needle could just cause an infection.

Be patient.

Dr. Pope, MD

[RyGuy14]

Thank you for the reply, Dr. Pope! I'm glad you think it's getting better.
When you say several weeks, does that mean no strenuous activity past the projected 4 week mark that my surgeon gave me originally? Or do you think it would be safe to continue my exercise regimen at the end of week 4 as originally prescribed by my surgeon?

[George Pope, M.D.]

I would put off upper body weights for a few more weeks.

Dr. Pope, MD
 

[RyGuy14]

Thanks for your help doc, I really appreciate it. I've been taking ibuprofin for the last 2 days and has really helped with the bruising and swelling. I'll update everyone in 5 days with hopeful progress.

[RyGuy14]

Here we go, about 6 days after the last pictures. 4th week post op. Ever since the last pictures I've been taking 800mg ibuprofen with breakfast and another 800mg with dinner. I've also been using the heating pad for about an hour a day. The hematoma has greatly reduced! It's about 95% gone! I'm very impressed with how this has turned out! I will continue to do this for about another week before I have to go back to Colorado.

Unfortunately I can't update with pictures at this time because I can't log into my account on my computer due to a cookie issue, so I'm posting on my phone. The sterile strips are all off the right side and about 80% gone on the left. Healing very nice with virtually no scars.