Question about swelling after surgery

[Xavier]

My surgery was completed exactly 4 weeks ago, but sadly the recovery hasn't been that great.

2 weeks after surgery I noticed that the right side was swollen significantly, so I went back into my surgeon's office to have it looked at. Turned out my right side was full of a dark red fluid. All fluid was removed and both sides looked even. I was happy.

3 weeks ago I saw that the swelling came back again but it wasn't as much as before so I didn't think much about it until a few days ago.

1 week later (today, 4 weeks post op), went to see my surgeon again as the same side looked almost as large as the first time I went. This time my surgeon didn't find any fluid in my chest and said it was swollen tissue and claimed it will subside on its own.

What are your experiences in cases like this?

[Dr. Elliot Jacobs]

What you are describing is a hematoma.  Sometimes a hematoma can be drained with a needle (if it is small).  However, hematomas are often much larger (in volume) than they appear on the surface.

It is my personal philosophy and practice to bite the bullet when confronted with a hematoma:  the patient is returned to the OR for a 15 minute procedure to remove the hematoma, put in a drain and suture the nipple.  Recurrence of the hematoma, when treated in this way, is very rare.

If a significant amount of blood remains in the tissues, it will undoubtedly turn into space-occupying scar tissue and the result will be a larger breast on the affected side.  Then, revision surgery in the face of excess scar tissue is very difficult.

Dr Jacobs

[Xavier]

That sounds serious... My surgeon saw me 3 times after surgery and said that everything is going OK and that this is all part of the healing process. He said that the excess fluid which he removed with a needle came from the liposuction and was normal. How could he overlook something so serious, even today when he noticed he couldn't remove fluid? I am leaving the Country in 3 weeks and won't be back for months so I don't know what to do now... Would it help if I send you a few pictures?

[Litlriki]

Just joining in here, as Dr. Jacobs indicated, it's best to evacuate the hematoma when possible, either surgically or by aspiration.  Many patients who get a small hematoma on one side can be serially aspirated over the course of a couple of weeks, and in most instances, the end result is comparable by 6 to 8 weeks.  But it requires frequent follow up to do this, and compression should be used in between to minimize re-accumulation (of serous--thin yellowish--fluid, rather than hematoma, normally).  If this isn't effective, or depending on the timing, re-opening the incision and removing hematoma can be quicker and more definitive.  Sometimes, when attempts at aspiration are carried out, the fluid isn't easily drained, because it is in small pockets, and the needle only drains a portion.  It's possible that your surgeon wasn't able to get into the fluid pocket.

It sounds like the timing is not great for you, so you may want him to address it surgically to get it over and done with more efficiently.

Rick Silverman

[DrPensler]

I would agree sounds most likely to be a hematoma. Fluid is more likely to accumulate when there is a lot of loose skin. Things move along a bit quicker if the fluid is removed.This usually will not impact the final result. As a rule of thumb in patients who develop a hematoma I tell the patient that 50% will require re aspiration , and with each re aspiration the likely need to re aspirate decreases by 50%. In some patients I will place a drain but I find that patients prefer re aspiration usually to a drain. In any case it sounds as though your surgeon has things under control.

[Xavier]

Doctors,

Thanks for the answers.

Like Dr. Pensler said, I think he has things under control as he checked the swelling multiple times and said it will resolve on its own. But if things do not improve in the coming days and weeks I will have to contact him again and explain the situation.