Breast hematoma

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.