Questions Regarding Hematomas After Surgery

[egibb]

As of this post I am about 8 days PO.

Backstory:
My doctor removed my glands on both sides(not a lot to begin with, probably the size of 2 almonds on each side). There was no need to lipo.

In conjunction to the gynecomastia surgery I received a nipple reduction on both sides.

My right side is perfect. Its flat and the nipple doesn't protrude. However, my left side is still puffy. It looks worse than what it was in the beginning. I know it is still early to tell how the final result will be and I still need to wait for the swelling/bruising to go down.

I visited my doctor and told me that I had a hematoma. We tried to aspirate it, but not a lot came out. After the first aspiration the nipple is a little less puffy, but the hematoma is still present.

I made an appointment to visit again next week to aspirate it again.

My question are:

(1). Will the hematoma resolve on it's own and chances of it happening?

(2). How long is too long for the hematoma to be in me for it to become an infection?

(3). Will the hematoma liquify by itself so it can be aspirated?

(4). If it does need to be surgically removed how would the surgeon go about doing that and would the scar be more pronounced?

(5). As a surgeon, what would you recommend I do? Wait for the hematoma to resolve on its own, continue to aspirate it, or surgically remove it.

(6). Should I be using heat or ice and should I massage the area?

(7). Because of the hematoma am I more prone to having a bigger scar tissue? If so, would kenalog/cortisone be a viable option to help smooth out my nipple?

(8 ). My nipple/areola is now stretched because of the hematoma. Does that mean I'll need to undergo another nipple reduction?



I am genuinely concerned. Hopefully someone can help answer me questions.

Thanks

Picture Post:


Pictures Before:
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[Dr. Elliot Jacobs]

Yes, in the one photo and according to your history provided, it may be that you have a hematoma.

Let me describe what I do in my practice, which may not be what other doctors do.

Yes, if you wait around 10-14 days, you may be able to aspirate a small hematoma with a syringe.  Multiple aspirations may be needed.  Any remaining blood will eventually be absorbed by your body and may result in added scar tissue, which may make one side look larger than the other side.  This may be treatable with cortisone down the line -- but it may require multiple injections over time.

Many surgeons do not like to re-operate because, in truth, it is a hassle for the surgeon to go back a second time. 

I believe that any hematoma should be recognized and re-operated on.  It need not be done on an emergency basis -- anytime from within hours after surgery up to two weeks or more will do.  The operation is relatively straight forward -- open the sutures, remove the blood clot, clean the area, stop any small bleeder, and then re-suture.  this usually takes 15 minutes in my operating room.  The result is that within a week or so, the hematoma side looks identical to the normal operated sided and one is not faced with multiple aspirations, delayed healing, unequal sides and possible need for multiple cortisone injections.

I do not charge my patients anything for re-operation for hematoma -- I consider it part of their original fee.

Others surgeons may take a different approach.  Best to discuss with your surgeon.

Dr Jacobs