What causes a haematoma after breast surgery?

A breast haematoma can have several causes. Sometimes a blood vessel that was controlled during surgery can begin bleeding afterwards, while in other cases minor bleeding may gradually cause blood to accumulate.

Factors that may contribute include:

• Bleeding from blood vessels following surgery
• High blood pressure causing a vessel to bleed
• Blood-thinning medicines
• Certain medical conditions affecting blood clotting
• Trauma to the chest area during recovery
• Vigorous exercise or physical strain too soon after surgery
• More extensive or complex surgery

Your breast surgeon should assess relevant risk factors before operating and take reasonable steps to control bleeding during surgery.

However, it is not always possible to prevent a breast haematoma. A patient can develop one even where their surgeon has followed the appropriate standard of care.

How common are breast haematomas?

Haematoma is a recognised complication of breast surgery. Some estimates place the rate of haematomas following cosmetic breast procedures at approximately 2–10%, although the likelihood varies considerably according to the operation, patient and how a haematoma is defined.

A breast augmentation involving breast implants, for example, differs considerably from breast conserving surgery for breast cancer or more extensive breast reconstruction. The individual patient's health, medication and complexity of surgery can also affect risk.

The fact that a haematoma is a recognised risk is important when considering negligence. Its presence does not establish that something was done incorrectly.

What are the signs of a haematoma after breast surgery?

Normal post-operative swelling should generally become more manageable as the healing process progresses. A breast haematoma may cause a more noticeable or sudden change.

Possible symptoms include:

• Rapidly increasing swelling
• One breast becoming larger than the other
• Increasing tightness or pressure
• Significant pain or tenderness
• Extensive or worsening bruising
• A lump or mass formation caused by clotted blood
• Changes in breast shape
• Blood seeping through the wound dressing
• The affected area becoming increasingly firm

Where bleeding is more substantial, a person may also feel faint, weak or generally unwell.

Heat and redness around the breast can also be signs of infection, particularly when accompanied by fever or discharge. These symptoms should be medically assessed rather than assumed to be part of a haematoma.

Haematoma or normal bruising: how can you tell?

Bruising and swelling are expected after many forms of breast surgery because the procedure affects the skin, breast tissue and small blood vessels.

Normal bruising will often change colour and gradually fade over a few weeks. Swelling should also gradually improve rather than rapidly increase.

A breast haematoma may be more likely where:

• Swelling develops suddenly or becomes substantially worse
• One breast becomes noticeably larger
• The breast becomes increasingly hard or tight
• Pain and swelling increase rather than improve
• The breast shape changes unexpectedly
• A firm lump develops around the operation site

You should not try to diagnose a breast haematoma yourself. Contact your surgeon or another medical professional if your recovery changes unexpectedly or you are concerned about your symptoms.

Is a breast haematoma dangerous?

Many people want to know: is a breast haematoma dangerous? A small, stable haematoma may be absorbed naturally by the body and cause no lasting problems. This can take a few weeks and sometimes longer, depending on the amount of accumulated blood.

A large haematoma or one that is continuing to expand can be more serious. The swelling caused by the collected blood can place pressure on surrounding breast tissue, causing significant pain and potentially interfering with the healing process.

Larger haematomas may also increase the risk of further complications, including wound problems, infection or tissue damage. Following breast augmentation, an untreated haematoma is associated with an increased risk of capsular contracture around breast implants.

Rapidly worsening symptoms therefore require prompt medical assessment.

When should you worry about a haematoma after surgery?

Contact your surgeon or seek medical attention if you develop:

• Rapid or substantial swelling
• Severe or increasing pain
• Sudden breast asymmetry
• Significant tightness or firmness
• Heavy or continuing bleeding
• Fever, redness, heat or other signs of infection
• Dizziness, weakness or fainting
• Symptoms that are getting worse rather than improving

Severe symptoms or rapid deterioration may require urgent hospital assessment.

Your health should always take priority. If you are concerned about a complication, do not delay seeking treatment because you are worried about whether it could affect a potential breast surgery negligence claim.

How is a breast haematoma diagnosed?

A surgeon will usually consider your symptoms and carry out a physical examination of the breast and operation site.

Depending on the circumstances, imaging may be used to determine whether blood has collected and assess the size of the haematoma.

The appropriate investigation will vary depending on the procedure you underwent, how long ago your surgery took place and the severity of your symptoms.

How is a breast haematoma treated?

Treatment depends on the size of the breast haematoma and whether bleeding is continuing.

Monitoring a small haematoma

A small haematoma that is stable and causing limited symptoms may not require another operation. The body can gradually break down and absorb the clotted blood during the healing process.

Follow-up appointments are important so that the surgical team can check whether the swelling and bruising are improving.

Draining a larger haematoma

Where a larger collection of blood is causing significant pain or pressure, drainage may be considered.

In selected circumstances, accumulated blood may be removed through aspiration, potentially using ultrasound guidance. Whether this is appropriate depends on factors including the age and consistency of the collection.

Returning to surgery

A large haematoma, continuing bleeding or significant pressure on surrounding tissues may require a return to the operating theatre.

The surgeon may reopen the operation site, remove accumulated blood and blood clots, identify the source of bleeding and control it before closing the wound again.

Importantly, needing another operation to treat a breast haematoma is not evidence that the original surgery was negligent. Promptly returning a patient to theatre can instead demonstrate appropriate management of a recognised surgical complication.

How long does a breast haematoma take to go away?

Small breast haematomas may resolve naturally within a few weeks, although the exact time frame will vary.

Larger collections can take longer and may require treatment rather than waiting for the body to absorb them.

Recovery will vary depending on the size and location of the haematoma, the original breast surgery and whether further treatment is needed.

Your surgeon should monitor your recovery and advise when additional investigation or treatment is necessary.

Can a haematoma after breast surgery be prevented?

Not every breast haematoma is preventable. Even where a competent surgeon follows the correct procedure and successfully controls visible bleeding, a blood vessel can begin bleeding after the wound has been closed.

This is why the presence of a haematoma should not automatically be described as negligent surgery.

Instead, the important question is whether the surgeon met their duty of care before, during and after breast surgery.

What should your surgeon do before surgery?

Before operating, your surgeon should assess whether you are suitable for the proposed procedure and identify relevant factors that could increase the risk of bleeding.

This can include reviewing:

• Your medical history
• Medicines, including blood thinners
• Previous surgery
• Conditions affecting bleeding or clotting
• Other individual risk factors

Your surgeon should also explain the material risks of the procedure, realistic outcomes and reasonable alternatives so that you can make an informed decision.

Patients should not stop prescribed blood thinners unless instructed to do so by an appropriate medical professional.

How should bleeding be controlled during breast surgery?

During surgery, the surgeon should use appropriate techniques to identify and control bleeding. This is known as haemostasis.

Blood vessels that are bleeding should be appropriately managed before the surgical wound is closed. The surgeon should also perform the procedure to the expected professional standard and maintain suitable hygiene throughout.

Poor haemostasis increases the likelihood of a post-operative haematoma. However, the fact that blood collects after an operation does not prove that the surgeon failed to control bleeding properly.

Independent medical evidence would be needed to determine whether the surgical technique fell below the expected standard.

What monitoring should happen after breast surgery?

A surgeon's duty of care does not end when the operation finishes. After surgery, patients should receive appropriate monitoring and clear information about their recovery. This includes knowing which symptoms are expected and which require medical attention.

If a patient develops rapidly increasing swelling, significant pain or sudden changes to the affected breast, the surgeon or clinical team should appropriately assess these concerns.

Where a breast haematoma is suspected, further examination or treatment may be necessary.

Failing to recognise significant post-operative bleeding or delaying necessary treatment could cause further avoidable harm.

When could a breast haematoma involve negligence?

A breast haematoma itself is not a sign of negligence. A negligence claim would instead depend on evidence that the surgeon or medical team failed to meet the expected standard of care and that this failure caused or contributed to an avoidable injury.

Depending on the individual circumstances, concerns could arise where there was:

• Inadequate assessment of significant bleeding risks before surgery
• Substandard surgical technique or poor haemostasis
• Inadequate post-operative monitoring
• Failure to investigate rapidly increasing swelling or pain
• Failure to recognise significant bleeding
• An unreasonable delay in arranging treatment or surgical drainage

For example, a surgeon who recognises a haematoma and promptly arranges appropriate treatment may have provided entirely appropriate care, even if the patient requires further surgery.

By contrast, ignoring clear signs of continuing bleeding until the patient suffers additional tissue damage could raise questions about whether the expected duty of care was met.

What other signs may suggest breast surgery has gone wrong?

A recognised complication should not be confused with negligence. What matters is whether the surgeon's actions before, during or after surgery fell below the expected standard.

Other outcomes that may indicate negligent breast surgery include:

• Significant asymmetry caused by poor surgical planning or performance
• Symmastia, where breast implants cross towards the centre of the chest
• Double bubble deformity, where the implant sits below the natural fold under the breast, creating a visible horizontal line
• Waterfall deformity, where the natural breast tissue slides down, leaving the implant sitting high and the tissue draped below it
• Persistent droopiness where an unsuitable procedure was performed
• Areola stretching associated with inappropriate technique
• Unexpected or inappropriately positioned scar tissue
• Failure to recognise or appropriately manage an infection

Whether any of these outcomes resulted from negligence would need to be assessed using the patient's medical records and independent expert evidence.

What should I do if I think I have a breast haematoma?

If you are experiencing symptoms of a breast haematoma, your immediate priority should be obtaining appropriate medical care.

Contact your surgeon or clinic and explain your symptoms. If you have severe pain, rapidly increasing swelling, substantial bleeding, faintness or other serious symptoms, seek urgent medical attention.

It can also be useful to keep photographs of changes to the affected breast and retain copies of your medical records, aftercare instructions and correspondence with the clinic.

These documents may become relevant if you later have concerns about whether your complication was managed appropriately.

Can I claim compensation for a breast haematoma?

You cannot assume that you have a compensation claim simply because a haematoma developed after breast surgery.

Haematomas are a recognised risk and can occur despite appropriate treatment.

To pursue a cosmetic surgery negligence claim, it would usually need to be shown that the surgeon breached their duty of care and that this breach caused or contributed to avoidable harm.

For example, independent medical evidence might establish that inadequate haemostasis caused preventable bleeding or that an unreasonable delay in treating a large haematoma resulted in additional injury. Each case needs to be considered individually.