Expert: Alan M. Engler, MD, FACS - 4/10/2007

Question
I am 3 weeks post op silicone, under the muscle. I was not banded after surgery, developed large hematoma in one breast,no treatment was done. That implant is still very high. The hematoma seems to be absorbing but still very bruised. I am worried about the implant not settling into it's pocket due to tissue reaction of the hematoma. Should it have been drained or opened to evacuate the clots and bring down the implant. I don't want to be a PIA and cause any problems with my surgeon but I feel miss managed. What is the normal approach to handling this complication

Answer
Dear Abby,

I don't know that there's an absolute answer as to handle this, but there are a few general principles.  Ideally, once a hematoma is recognized you would like to get it out as quickly as is reasonably possible.  That depends to a certain degree on when it's recognized, and how significant it is.

If noted early (the first few days) and/or very large, it will typcially require a return to the operating room.  At that point, the implant is removed, the blood clots are evacuated, the pocket is washed out and, if everything is okay, the implant can be reinserted.  Obviously, that requires deep anesthesia (general or deep intravenous sedation), and may require a hospital stay.  If there is persistent bleeding, it may not be possible to reinsert an implant.

The longer it takes to recognize the bleeding, and the smaller it is, the more reasonable it would be to either let it resolve on its own, or reinsert some drains (which can often be done under local anesthesia).  The clots liquefy, and can be more easily removed at that point (after about a week or so).

You need to avoid leaving the blood in there, as it can become infected (requiring removal of the implant for several weeks or months before it can be reinserted) or, as in your case, leaving the implant too high.

As long as the blood is resorbing, the most likely thing necessary would be to lower the implant (in a few months).  This is annyoing but not necessarily dangerous, etc.  It's hard to say what to do at 3 weeks.  If it's resolving well, you can continue the present course and see how it settles.  It's not a bad idea to consider reinserting a drain, even at this point, but that is a judgment call I cannot make via this forum.

You should stay in touch with your PS and discuss how he/she plans to address the high-riding implant if it does not descend adequately on its own (it still may, but it's good to know what the options are).

The above, at any rate, are my thought on how I would address these issues; that's not the same as saying there's only way to do things, of course.

I hope that this helps, and good luck,

Dr. E
www.bodysculpture.com