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.
A well-circumscribed, thick-walled cystic lesion containing, upon opening, obvious organizing hematoma and brown-stained liquid is usually noted.
Organizing hematoma appears with or without surrounding fibrosis, granulation or fat necrosis depending on the age and etiology of the lesion.
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.
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.
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