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Hematoma


A hematoma is a collection of blood inside the body.

With breast augmentation the build-up of blood pooling is within the breast itself around the implant and or the incision from a broken blood vessel. Usually this symptom occurs soon after the actual surgery; however you can have a hematoma occur within several weeks post operative.


 

Causes of hematomas:

  • Blood thinners taken before surgery, such as aspirin and anti-inflammatories

  • Drinking alcohol before surgery

  • Patients with elevated blood pressure

  • Coagulant Disorders

  • Excessive Heat

  • Physical Exertion after surgery
     

 

Post operative bleeding is caused by a number of different reasons and sometimes the actual reason on why it has happened remains unknown. During the surgery before the incision is closed, surgeons are careful to control any bleeding vessels. These bleeding vessels are usually cauterized with an electrical current which forms a clot. During the healing stage of recovery, the clot may fall off and allow the blood vessel to start bleeding again.

To help reduce the chances of a hematoma occurring after breast surgery or any other cosmetic surgery procedure, avoid taking any blood thinners at least two to three weeks prior to and after your surgery. Blood thinning medication includes all drugs that contain aspirin, ibuprofen, Vitamin E, and Garlic supplements. Also, refrain from drinking alcohol for a period of time as well, as this can also thin the blood.

Patients can sometimes have a certain bleeding disorder, with a reduced ability to clot properly. These causes can be unknown.

 

 
Tell your surgeon before your surgery if you have any of the following:

  • History of easy bruising

  • Post-operative bleeding

  • Heavy Periods

  • Family history of bleeding disorders
     

 

 

Hematomas may develop slowly without symptoms or rapidly with symptoms. The smaller a hematoma the better it is for the patient as these usually resolve without any kind of intervention; however large hematomas usually require some kind of medical or surgical care. Draining the hematoma aids in proper healing, and although there might be a tiny scar from the actual draining, most of these heal without any kind of scarring.



Symptoms of a hematoma:

  • Unilateral pain

  • Firmness

  • Increased swelling

  • Occasionally fever

  • Bruising and or discoloration

 

Normally hematomas arise within the first week following surgery. If a hematoma is present almost immediately after surgery, then more than likely a blood vessel has been broken. There are some hematomas which can occur up to couple weeks after surgery, and this is in correlation to the natural phase of clot lysis. During this time, your body naturally reabsorbs blood clots which were formed during surgery. If you are exerting yourself physically during this time, then the risk of hematoma increases.

 

 

 

The way that surgeons prevent a hematoma from occurring is one of three ways.

 

 

 

A hematoma is a collection of blood in the surgical site which sometimes requires some surgical intervention, including re-opening the wounds, evacuating the blood clot, and try to find the source of the bleeding vessel if one can be found.

If the hematoma gets too large; it can compress the surrounding tissue in which will prevent oxygen from getting to the skin. This can cause the skin to possibly die. If this happens, the patient will need to return to the surgical room to have the bleeding stopped, the excess blood removed and finally a drain placed to prevent any further complications.

Sometimes the actual surgical procedure is done with a hematoma; the active bleeding can sometimes just stop on its own.


Complications that is caused from a Hematoma

 

                                            Photo of a patient with a large hematoma from a Bra-Line Back Lift procedure

                                           2010 Copyright CosmeticSurgeryForums.com

                                                         Patient had a "Bra-Line Lift"

                                       A hematoma formed within 24 hours after surgery

 

 

The risk of getting a hematoma is very low, less than 2 percent, however for the patients who have taken aspirin or ibuprofen before surgery, the risk is higher. It is also higher in those patients who return to a physically demanding occupation or resume exercise too soon.

To reduce your chances of getting a hematoma, it is wise not to increase your heart rate during your recovery for a period of four to six weeks. Limiting the exertion with exercising will help reduce this risk. Having a pre-operative evaluation by your plastic surgeon before surgery with help with telling your physician underlying problems you might have. Managing your blood pressure is very important, and by having this controlled before surgery, patients can significantly lower their risk for blood clots.

Hematomas are normally rare, and it normally is unusual to have post operative bleeding. But if this occurs, everything will be done to resolve the problem. By following your Plastic Surgeon’s Pre Operative Instructions will help tremendously, along with making sure you are forthcoming with any problems that might be related to this complication.
 




                                   Seroma  on CosmeticSurgeryForums.com

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Seroma

A seroma is an accumulation of fluid in the surgical area, usually occurring right after surgery; it can also occur after an injury to the area. A seroma can be drained and usually resolve within a few weeks; however with a smaller seroma - the body usually has no problem absorbing these. Most plastic surgeons will drain the fluid with a syringe and needle using a technique known as aspiration.

Seromas are one of the most difficult complications of plastic surgery. They can occur in the presence of a foreign body (such as a breast implant) or in the absence of one (such as after an abdominoplasty).

The more extensive a surgical procedure is; the more likely a seroma could possibly occur. The larger the seroma, the longer it will take to resolve to resolve; and also the more likely the fluid could be complicated by a secondary infection.  Diagnosis of a seroma can include the patient having an ultrasound.



 

Symptoms of a Seroma include bulging of surgical site and fluid-like movement under site on touch/compression.

Treatments for Seromas

  • Repeat aspiration and compression

  • Insertion of a drain if needed

  • Injection of tetracycline into the drain tube

  • In problematic cases, explore and remove the seroma cavity

  • Possible removal of the breast implant

     

The critical issue is the fact that this fluid inside the seroma is a good media for bacterial growth and if infection occurs an abscess will be formed. Surgical drainage and a course of antibiotics will help prevent an infection from starting.

If your surgeon has suggested a drain to be left in place to help drain the seroma, it depends on the individual patient needs on how long it will stay in place. Drains can stay in from a day to several weeks, depending on how much fluid is being accumulated.

The benefit of a drain is that it helps to avoid a collection of blood (hematoma) or fluid (seroma). It also will pull the skin against the underling tissue and promote closure of a space.

Untreated seromas can lead to a pseudo-bursa formation, in which a layer of scar tissue (the pseudo-bursa, or fake sac) forms around the fluid. In breast augmentation, a seroma of the breast can lead to capsular contracture.

Exercise increases your heart rate and blood pressure which lead to increased swelling.  Exercise also causes friction of your tissues from all the movement which also leads to more fluid production. Refraining from getting your heart rate too high will help you resolve a seroma faster.



 

Removing a seroma without rupturing the breast implant can be difficult, so if the volume of the seroma is small, the fluid is sometimes left to reabsorb on its own. Occasionally, the fluid volume is too great and causes symptoms and must be drained.  Most plastic surgeons will drain the fluid with a syringe and needle using a technique known as aspiration.  Seromas around a breast implant are very important to drain, because if the fluid becomes infected, the patient could possibly lose their implant for a period of time.

Draining a seroma with a breast implant present is often harder to deal with because of the issue of the implant being compromised by the needle used to aspirate.

Aspiration is a minor drainage technique, requiring a needle and syringe to withdraw the collection of fluids. The greatest risk associated with aspiration is possibly the puncturing of the implant in which it could cause leakage and or deflation.

Some surgeons might opt for ultrasound-guided aspiration in the hopes of having a clearer picture on where the implant is situated so that the risk of puncturing doesn’t occur.

Repeated aspirations increase the risks of infecting the seroma and needing to remove the breast implant, and sometimes, additional corrective surgery is required.  A surgical drain is inserted into the breast tissue to discourage further fluid collection.  Inserting a drain is a minor procedure. However, some sort of anesthetic or light sedation is given to the patient before the procedure, so that they are comfortable.

Textured implants can sometimes be associated with a little more fluid formation.



 

 

A seroma is a collection of fluid that continues to accumulate. Seroma refers to a collection of serous fluid (the pale yellow straw colored fluid that is produced by lymph vessels and by the tissues that lie under the skin). The formation of these fluid collections is facilitated by the disruption of lymphatics and blood vessels as well as by the creation of large potential voids beneath the skin.


Post operative problems due to seroma formation in breast reduction or reconstruction:

Drains are standard protocol with breast reconstruction surgery, as it is normal for some fluid to collect in the area. Drainage tubes are put in place to help with any excess fluid, and this helps with keeping the complication of a seroma from happening. However, sometimes a hematoma or a seroma will develop under the incision and most of the time the body will absorb these naturally. But if these seromas or hematomas are large they are removed by aspiration using a small needle and a syringe, pressure applied and possibly have antibiotics injected to stop the collection of fluid. The purpose of the antibiotics (such as tetracycline) is essentially to stick the tissues together to help prevent the fluid from re-accumulating.

This is a common complication after a mastectomy and thought to be caused by the fact that the mastectomy surgical procedure left a lot of “empty space” under the skin where the breast tissue use to be. The walls around this empty space are raw and tend to ooze serous fluid. This causes it to gather up in the space beneath the wound. The fact that the walls of the empty space are inflamed seems to trigger the seroma fluid.

 

Reconstruction with implants

Reconstruction with implants - most surgeons like to wait on any aggressive treatment with the seroma, simply because of the fact the needle into the seroma could potentially rupturing the implants. However, reconstruction with patients who have had a TRAM flap, surgeons are more pro-active with aspirating seromas simply because there is no implant there to potentially rupture.

 

The Latissimus Dorsi Flap

The latissimus dorsi flap - is a common option in reconstruction of the breast for a breast cancer patient. Donor-site seroma is a commonly described post operative complication of the latissimus dorsi flap.  Increased age, obesity, and invasive breast surgery are risk factors for donor-site seroma formation after breast reconstruction with the latissimus dorsi flap.


 


 

Seromas are a know complication of procedures such as tummy tucks. A seroma is a collection of fluid that occurs after a procedure such as an abdominoplasty. With abdominoplasty a large cavity is created from removal of excess skin and fat.  Sometimes liposuction is performed with this procedure. The fluid collects from small lymphatic’s that are cut and this fluid may persist even after drain removal. If the seroma is large, aspirations might be done as an office procedure. Drains are often placed to help reduce this lymphatic fluid. With abdominoplasty the overall incidence can vary from 5 – 10 percent.

Early and prompt intervention usually prevents long standing problems caused by a seroma. Once a seroma has been diagnosed, it needs to be drained, immediately. This normally means the insertion of drains, that are left in place long enough to allow the fluid to come out and the overlying tissues to heal.

Liposuction of the flanks is a common procedure done with a patient who is undergoing an abdominoplasty. Having these two procedures together does not appear to increase the risk of seroma formation. However, patients who are overweight or obsess present a significantly higher risk for developing seromas post operatively than patients of normal weight.

Seroma accumulation is one of the more common problems seen following abdominoplasty however; it does not seem to alter the end cosmetic result. An abdominal binder or compression garment placed on the patient after the abdominoplasty helps facilitates fluid removal through the drains and promotes the compression of the fluid filled soft tissues. The binder is an essential part of post operative seroma management as it maximizes the efficacy of the drains and promotes adherence of the soft tissue flap to the underlying abdominal wall fascia.

 

 

 

  • Seroma and Liposuction

A hematoma that occurs during liposuction means bleeding into a closed area under the skin. Seroma defined is a pooling or leakage of fluid (blood serum) into a closed area beneath the skin. There have been reports of excess fluid with the Vaser type of liposuction.

If your surgeon decides to have the seroma drained, it is important to continue with the compression garment and decreased activity for another 4 weeks, or else this problem might resurface once again. A seroma is a possible adverse side effect of a liposuction procedure.


Conditions associated with Seroma in Liposuction:

  • Aggressive cross-suctioning

  • Liposuction using a large cannula

  • Inadequate wound drainage

  • Type of lipoplasty technique used
     

With liposuction, the seromas are caused by the cannula used to extract the fat, as it helps in draining fluids from the treatment area but it also makes a large cavity within the fatty tissue. Liposuction techniques such as Vaser UAL Laser cause additional damage to the tissues and can create a stronger inflammatory response from the body which will then produce more fluid resulting in a seroma. Having a large scale liposuction procedure will also contribute to making seromas more likely.

To treat the seromas, a needle is inserted and the serum is collected in a syringe. If the seroma goes untreated in the initial stages it can take several months to finally resolve it.

 

Prevention of Seromas in Liposuction:

  • Use of micro-cannulas

  • Draining lymphatic fluid after liposuction

  • Avoiding excessive liposuction

  • Using compression garments

  • Using the open drainage technique


     

 

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