Breast hematoma

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Breast hematoma

Breast hematoma is a collection of blood within the breast. It arises from internal bleeding (hemorrhage) and may arise due to trauma (breast injury or surgery) or due to a non-traumatic cause.

Contents

Symptoms

Symptoms may include visible discoloring (ecchymosis), breast pain, and swelling.

The symptoms may be similar to those of fibrocystic breast changes.

Causes

A breast hematoma may appear due to direct trauma to the breast, for example from a sports injury or a road accident, for example a vehicle collision in which a seat belt injury occurs.

Hematoma can also be a consequence of breast surgery, usually due to post-operative bleeding. Bleeding may occur shortly after the intervention or a number of days later and can occur for cosmetic surgery (for example breast reduction or breast enhancement) and for non-cosmetic surgery (for example lymph node removal, lumpectomy, or mastectomy). More rarely, hematoma can result from breast biopsy.

Rarely, a breast hematoma can also occur spontaneously due to a rupture of blood vessels in the breast, especially in persons with coagulopathy [1] [2] or after long-term use of blood-thinning drugs such as aspirin or ibuprofen. [3]

Pathophysiology

Small breast hematomas often resolve on their own within several days or weeks by means of reabsorption of the blood. Larger hematomas are more likely to lead to inflammation or fibrosis.

Breast hematomas can sometimes lead to skin discoloration, inflammation, or fever. When a hematoma resolves, it may become fibrotic, leaving behind scar tissue. A resolving hematoma may liquify to form a seroma.

Post-surgical breast hematomas can also impede wound healing and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast surgical site infections. [4] There is preliminary evidence that, after breast implant surgery, the presence of hematoma increases the risk of developing capsular contracture. [5]

In mammography screening, scar tissue resulting from a breast hematoma can easily be confused with tumor tissue, [6] especially in the first years following surgery. Ultimately, fat necrosis may occur in the concerned region of the breast. [1]

Diagnosis

When there is post-operative swelling after breast surgery or core needle biopsy, a breast ultrasound examination may be indicated in order to differentiate between a hematoma and other possible post-surgical complications such as abscess or seroma, [7] A recent hematoma is usually visible in a mammogram. [1] and it also shows typical signal intensities on MR imaging. [8] If a differentiation from breast cancer is necessary, a hematoma biopsy may be indicated.

A careful consideration of the case history is important for the diagnosis of a breast hematoma.

Treatment

Small breast hematomas that cause no discomfort often require merely clinical observation, with ultrasound being used to monitor the resolution of the hematoma.

Large breast hematomas, or those that are not becoming smaller or that are causing discomfort, usually require drainage. Also hematomas that occur after surgery for excision of a malignant tumor are drained, because a hematoma to which irradiation is applied is unlikely to ever resolve. [9] A recent hematoma can be drained by means of needle aspiration or (rarely) open surgical drainage.

Related Research Articles

Mammaplasty Surgically modifying the appearance of the breast

Mammaplasty refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are two main types of mammoplasty:

  1. Augmentation mammaplasty is commonly performed to increase the size, change the shape, and/or alter the texture of the breasts. This usually involves the surgical implantation of breast implant devices.
  2. Reduction mammaplasty is commonly performed to reduce the size, change the shape, and/or alter the texture of the breasts. This involves the removal of breast tissue.
Abdominoplasty Surgical procedure to make the abdomen thinner and firmer

Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss.

Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact is called a flap. In some instances a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in hemodialysis.

Chalazion Medical condition

A chalazion or meibomian cyst is a cyst in the eyelid usually due to a blocked meibomian gland, typically in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.

Nipple discharge Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

Cephalohematoma Type of hemorrhage

A cephalohaematoma is a hemorrhage of blood between the skull and the periosteum of any age human, including a newborn baby secondary to rupture of blood vessels crossing the periosteum. Because the swelling is subperiosteal, its boundaries are limited by the individual bones, in contrast to a caput succedaneum.

Fine-needle aspiration

Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin, hollow needle is inserted into the mass for sampling of cells that, after being stained, are examined under a microscope (biopsy). The sampling and biopsy considered together are called fine-needle aspiration biopsy (FNAB) or fine-needle aspiration cytology (FNAC). Fine-needle aspiration biopsies are very safe minor surgical procedures. Often, a major surgical biopsy can be avoided by performing a needle aspiration biopsy instead, eliminating the need for hospitalization. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center. Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions.

Umbilical hernia Medical condition

An umbilical hernia is a health condition where the abdominal wall behind the navel is damaged. It may cause the navel to bulge outwards—the bulge consisting of abdominal fat from the greater omentum or occasionally parts of the small intestine. The bulge can often be pressed back through the hole in the abdominal wall, and may "pop out" when coughing or otherwise acting to increase intra-abdominal pressure. Treatment is surgical, and surgery may be performed for cosmetic as well as health-related reasons.

Seroma Pocket of fluid that sometimes develops after surgery

A seroma is a pocket of clear serous fluid. They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical signs, and with a CT scan.

Fibrocystic breast changes Medical condition

Fibrocystic breast changes is a condition of the breasts where there may be pain, breast cysts, and breast masses. The breasts may be described as "lumpy" or "doughy". Symptoms may worsen during certain parts of the menstrual cycle due to hormonal stimulation. These are normal breast changes, not associated with cancer.

Breast cyst Medical condition

A breast cyst is a fluid-filled sac within the breast. One breast can have one or more breast cysts. They are often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Mammotome

A Mammotome device is a vacuum-assisted breast biopsy (VAC) device that uses image guidance such as x-ray, ultrasound and/or MRI to perform breast biopsies. A biopsy using a Mammotome device can be done on an outpatient basis with a local anesthetic.

Breast surgery is a form of surgery performed on the breast.

Fat necrosis Medical condition

Fat necrosis is a form of necrosis characterized by the action upon fat by digestive enzymes.

Renal biopsy

Renal biopsy is a medical procedure in which a small piece of kidney is removed from the body for examination, usually under a microscope. Microscopic examination of the tissue can provide information needed to diagnose, monitor or treat problems of the kidney.

Breast mass Localized swellings that feel different from the surrounding tissue

A breast mass, also known as a breast lump, is a localized swelling that feel different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.

Breast biopsy

A breast biopsy is usually done after a suspicious lesion is discovered on either mammography or ultrasound to get tissue for pathological diagnosis. Several methods for a breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the abnormality. The different types of breast biopsies include fine-needle aspiration (FNA), vacuum-assisted biopsy, core needle biopsy, and surgical excision biopsy. Breast biopsies can be done under ultrasound, MRI or a stereotactic biopsy technique. Vacuum assisted biopsies are typically done using stereotactic techniques when the suspicious lesion can only be seen on mammography. On average, 5-10 biopsies of a suspicious breast lesion will lead to the diagnosis of one case of breast cancer.

Gynecomastia Endocrine system disorder of human male breast

Gynecomastia is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of breast tissue as a result of a hormone imbalance between estrogen and androgen. Gynecomastia can cause significant psychological distress or unease.

Cosmetic surgery, also referred to as aesthetic surgery, is a surgical procedure which endeavours to improve the physical aspects of one's appearance to become more aesthetically pleasing. The continuously growing field of cosmetic surgery is closely linked with plastic surgery, the difference being, cosmetic surgery is an elective surgery with the sole purpose to enhance the physical features of one's appearance. Plastic surgery is performed in order to rectify defects to reinstate normality to function and appearance. Cosmetic surgical procedures are generally performed on healthy functioning body parts, with the procedure being optional not medically necessary. The inevitable aim of cosmetic surgery is to enhance one's image, encompassing reducing the signs of aging and/or correction of a believed deviation on one's body in turn it is surrounded by controversy. Although the implementation of cosmetic surgery within Australian society is growing, the trade has struggled to find its place within the Australian culture.

Breast imaging

In medicine, breast imaging is a sub-speciality of diagnostic radiology that involves imaging of the breasts for screening or diagnostic purposes. There are various methods of breast imaging using a variety of technologies as described in detail below. Traditional screening and diagnostic mammography uses x-ray technology. Breast tomosynthesis is a new digital mammography technique that produces 3D images of the breast using x-rays. Xeromammography and Galactography also use x-ray technology and are also used infrequently in the detection of breast cancer. Breast ultrasound is another technology employed in diagnosis & screening and specifically can help differentiate between fluid filled and solid lumps that can help determine if cancerous. Breast MRI is, yet, another technology reserved for high-risk patients and can help determine the extent of cancer if diagnosed. Lastly, scintimammography is used in a subgroup of patients who have abnormal mammograms or whose screening is not reliable on the basis of using traditional mammography or ultrasound.

References

  1. 1 2 3 "Breast hematoma". radiopaedia.org. Retrieved 18 November 2014.
  2. ↑ Salemis NS (2012). "Breast hematoma complicating anticoagulant therapy: management and literature review". Breast Disease (review). 34 (1): 25–8. doi:10.3233/BD-130344. PMID   23507668.
  3. ↑ Michael S. Sabel (23 April 2009). Essentials of Breast Surgery: A Volume in the Surgical Foundations Series. Elsevier Health Sciences. p. 177. ISBN   978-0-323-07464-3.
  4. ↑ Xue, D.Q.; Qian, C.; Yang, L.; Wang, X.F. (2012). "Risk factors for surgical site infections after breast surgery: A systematic review and meta-analysis". European Journal of Surgical Oncology (review). 38 (5): 375–381. doi:10.1016/j.ejso.2012.02.179. ISSN   0748-7983. PMID   22421530.
  5. ↑ Handel, Neal; Cordray, Tracy; Gutierrez, Jaime; Jensen, J Arthur (2006). "A Long-Term Study of Outcomes, Complications, and Patient Satisfaction with Breast Implants". Plastic and Reconstructive Surgery. 117 (3): 757–767. doi:10.1097/01.prs.0000201457.00772.1d. ISSN   0032-1052. PMID   16525261. S2CID   15228702., see sections "Results" and "Conclusions"
  6. ↑ Beverly Hashimoto; Donald Bauermeister (1 January 2011). Breast Imaging: A Correlative Atlas. Thieme. p. 69. ISBN   978-1-60406-445-2.
  7. ↑ Christof Sohn; Jens-U. Blohmer; Ulrike Hamper (1999). Breast Ultrasound: A Systematic Approach to Technique and Image Interpretation. Thieme. p. 98. ISBN   978-3-13-111531-7.
  8. ↑ Ulrich Brinck (January 2004). Practical MR Mammography. Thieme. p. 99. ISBN   978-3-13-132031-5.
  9. ↑ W. G. Cance (1 January 2001). Breast Surgery. IOS Press. p. 96. ISBN   978-1-58603-159-6.
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