Breast hematoma

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Breast Hematoma can occur secondary to surgical intervention, including FNAB, core biopsy and excision biopsy. The most common cause of postoperative Hematoma is inadequate hemostasis. Breast Hematoma also occurs after minor trauma to the breast with patients presenting with a tender mass associated with overlying bruising in the early phase following injury. When patients present late, the only clinical feature might be an underlying mass, which should be investigated thoroughly. It should be noted, however, that a history of trauma may not always be present since, often, the injury is trivial.

Pathology
Macroscopic Appearance
A well-circumscribed, thick-walled cystic lesion containing, upon opening, obvious organizing Hematoma and brown-stained liquid is usually noted.

Microscopic Appearance
Organizing Hematoma appears with or without surrounding fibrosis, granulation or fat necrosis depending on the age and etiology of the lesion.

Management
Postoperative Hematomas that are enlarging should be evacuated under general anesthesia. Analgesia and support of the breast with a well-fitting brassiere will provide some relief of symptoms. If the Hematoma liquefies, as demonstrated by fluctuation, aspiration may provide some relief. Short-term clinical follow-up to ensure resolution of symptoms may be necessary.

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Breast Hematoma and necrosis is a rare complication of anticoagulation treatment. An unusual case of this complication after mitral valve replacement and one-vessel coronary artery by-pass is reported. Breast haematoma appeared on the third postoperative day. Normal coumadin loading dose had just been given to the patient and International Normalized Ratio was excessively increased without underlying pathology or known predisposing factors. Mastectomy was unavoidable 10 days after the cardiac operation.

References

1. Roberts MM, Elton RA, Robinson SE et al. Consultations for breast disease in general practice and hospital referral patterns. Br J Surg 1987; 74:1020-1022.
2. Cochrane RA, Singhal H, Monypenny IJ et al. Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines. Eur J Surg Oncol 1997; 23:198-201.
3. Hughes LE, Mansel RE, Webster DJT. Aberrations of normal development and involution (ANDI): A new perspective on pathogenesis and nomenclature of benign breast disorders. Lancet 1987; 2:1316-1319.
4. Minton JP, Foecking MK, Webster DJ et al. Response of fibrocystic disease to caffeine withdrawal and correlation of cyclic nucleotides with breast disease. Am J Obstet Gynecol 1979; 135:157-158.
5. Boyd NF, McGuire V, Shannon P et al. Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988; 2:128-32.
6. Horrobin DF. The effects of gamma-linolenic acid on breast pain and diabetic neuropathy: possible noneicosanoid mechanisms. Prostaglandins Leuko Essent Fatty Acids 1993; 48:101-104.
7. ...

Complete References

A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002

RELATED STORIES:
Experimental Model for human proliferative Breast Disease   Nipple Discharge   Molecular Biology of Preliferative Breast Disease   Benign Breast Diseases: Classification, Diagnosis, and Management   Nodularity   Fibrocystic Condition   Biology of High Risk Benign Breast Lesions - Introduction   Fibromatosis of the breast   Optimizing the Antihormonal Treatment and Prevention of Breast Cancer   Fibroadenoma of the Breast   Carcinoma of the Female Breast   Assessment of new technologies   What measurable risk factors are associated with breast cancer?   Radiation Therapy Local Recurrence   Breast Cancer in Black Women   Technique of Axillary Dissection   Conclusion - Biology of High Risk Benign Breast Lesions   Multiple Peripheral Papillomas   Mondor Disease   Breast Cancer after Childhood Cancer   Principles of Cancer Screening   Axillary Surgery

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