Breast Hematoma: Symptoms, Types, Causes and Treatment

A breast hematoma can be an unexpected and sometimes alarming complication, whether it follows surgery, trauma, or arises spontaneously. Understanding its symptoms, types, underlying causes, and available treatments can help patients and healthcare professionals manage this condition effectively and minimize complications. This comprehensive guide uses current medical literature to provide clear, evidence-based answers to the most common questions about breast hematoma.

Symptoms of Breast Hematoma

When a hematoma forms in the breast, it can cause a range of symptoms—some subtle, others more dramatic. Recognizing these signs early is vital for timely intervention and optimal recovery.

Symptom	Description	Onset	Source(s)
Swelling	Localized breast enlargement	Sudden	2 3 4 5 10
Pain/Tenderness	Soreness or sensitivity	Rapid	1 2 3 4 5 10
Discoloration	Bruising or redness on the skin	Early	3 4 5 10
Firmness/Mass	Palpable lump or firmness	Immediate	3 4 5 6 7
Hypotension	Low blood pressure (severe cases)	Acute	1 2
Vasovagal Signs	Dizziness, fainting, bradycardia	Acute	2
Systemic Signs	Anemia, fatigue (large hematomas)	Later	1 2

Table 1: Key Symptoms of Breast Hematoma

Common Presentations

Most breast hematomas present with swelling, pain, and a noticeable change in breast contour. The skin may appear bruised or reddish-purple, and the area might feel firm to the touch. Discomfort can range from mild tenderness to significant pain, depending on the size and location of the hematoma 3 4 5 10.

Severe and Systemic Symptoms

In rare cases—especially with larger hematomas or those associated with bleeding disorders or anticoagulation—systemic symptoms such as hypotension (low blood pressure), dizziness, and even syncope (fainting) may occur. Such symptoms are often related not only to blood loss but also to a vagal nerve response triggered by the pressure of the hematoma on the chest wall 1 2.

Vasovagal and Autonomic Manifestations

Some patients experience vasovagal symptoms, including dizziness, somnolence (drowsiness), and a slow heart rate. These can be disproportionate to the volume of blood loss and are thought to arise from mechanical stimulation of the vagus nerve by the expanding hematoma 2. This unique response underscores the importance of individualized assessment and management.

Types of Breast Hematoma

Not all breast hematomas are the same. They vary by timing, location, and underlying cause, which can influence both their presentation and management strategies.

Type	Description	Timing	Source(s)
Acute	Occurs within hours to days after an event	Early	3 4 5 10
Late	Develops weeks, months, or years post-event	Delayed	4 5 6
Intracapsular	Within the implant capsule	Any	4 5 6
Extracapsular	Outside the implant capsule	Any	4 5 6
Spontaneous	No obvious trauma or surgery	Any	1 4 10
Traumatic	Directly related to injury or intervention	Immediate	3 5

Table 2: Types of Breast Hematoma

Acute vs. Late Hematomas

• Acute hematomas typically occur soon after surgery, trauma, or a procedural intervention. They are the most common type, particularly after breast augmentation, reduction, or biopsy 3 4 5 10.
• Late hematomas are rare and may appear months or even years after breast surgery, particularly in those with breast implants. These can be triggered by implant-related issues, minor trauma, or even vigorous squeezing, as described in some case reports 4 5 6.

Intracapsular vs. Extracapsular

• Intracapsular hematomas are confined within the fibrous capsule that forms around a breast implant. These are particularly relevant in the context of late complications after implant-based reconstruction or augmentation 4 5 6.
• Extracapsular hematomas are located outside this capsule and may involve the surrounding breast tissue more diffusely.

Spontaneous vs. Traumatic

• Spontaneous hematomas occur without any direct trauma or recent surgical intervention and are most often associated with anticoagulation therapy or underlying bleeding disorders 1 4 10.
• Traumatic hematomas are directly related to injury—either from an accident, vigorous manipulation, or procedural events such as surgery or biopsy 3 5.

Causes of Breast Hematoma

Understanding what leads to a breast hematoma can help guide both prevention and management. The causes span a wide spectrum, from surgical complications to spontaneous events triggered by medications or underlying health conditions.

Cause	Mechanism	Risk Factors	Source(s)
Surgery/Procedures	Vessel injury during intervention	Recent breast surgery	3 7 8 9
Trauma	Blunt force or excessive manipulation	Accidents, vigorous activity	5 6
Anticoagulation	Impaired clotting leads to bleeding	Anticoagulant/antiplatelet use	1 10
Implant Complications	Capsule rupture, chronic inflammation	Breast implants	4 5 6
Spontaneous/Idiopathic	No obvious cause	Coagulopathies, age	1 4 10
Perioperative Factors	Hypotension, surgical technique	Anesthesia, blood pressure	3 8 9

Table 3: Common Causes of Breast Hematoma

Post-Surgical and Procedural Causes

Breast surgery is the leading risk factor for hematoma formation. Procedures such as augmentation, reduction, and mastectomy can all result in vessel injury and subsequent bleeding. In some cases, the use of certain medications (like NSAIDs or anticoagulants) around the time of surgery may increase risk 3 7 8 9.

Trauma and Mechanical Forces

Direct trauma, ranging from minor accidents to vigorous squeezing (even during sexual activity), can cause blood vessels within the breast or around an implant to rupture. These cases may be underreported due to embarrassment or because small hematomas often go unnoticed 5 6.

Anticoagulation and Bleeding Disorders

Patients on anticoagulant or antiplatelet therapy are at increased risk of spontaneous hematoma formation, even without trauma or surgery. While rare, these cases can be severe and may require specialized management 1 10.

Implant-Related Complications

Implant-related hematomas, especially late or intracapsular ones, may be triggered by chronic inflammation, capsular contracture, or minor traumas after the initial surgery. Over time, the implant capsule can become fragile and susceptible to bleeding 4 5 6.

Other Contributing Factors

• Intraoperative hypotension has been identified as a possible contributor, especially in breast reduction surgeries 3.
• The use of certain techniques, such as the choice of incision or pocket for implant placement, has inconclusive evidence regarding their effect on hematoma risk 3.

Treatment of Breast Hematoma

Treatment strategies for breast hematoma depend on its size, cause, timing, and severity. Recent advances offer less invasive options, but traditional methods remain important in certain cases.

Approach	Indication	Method/Outcome	Source(s)
Observation	Small, stable, non-expanding	Spontaneous resolution	5 10
Surgical Evacuation	Large/expanding, symptomatic	Open drainage, hematoma removal	3 5 6 7
Percutaneous Drainage	Moderate to large, non-infected	Ultrasound-guided aspiration/VAE	7
Pharmacologic	Prevention, high-risk patients	Tranexamic acid (IV/topical/oral)	8 9
Interventional Radiology	Active bleeding, unstable	Angiography and embolization	1

Table 4: Treatment Modalities for Breast Hematoma

Observation and Conservative Management

Small, stable hematomas without significant pain or skin compromise often resolve on their own over several weeks. Observation is appropriate in these cases, especially if the patient is not on anticoagulant therapy or has no signs of infection 5 10.

Surgical and Minimally Invasive Interventions

• Surgical evacuation is warranted for large, expanding, or symptomatic hematomas, especially when there is skin compromise or risk of infection. This remains the gold standard for acute post-surgical hematomas 3 5 6.
• Percutaneous aspiration or vacuum-assisted evacuation (VAE) is an emerging, less invasive alternative for large hematomas. VAE can be performed under ultrasound guidance, is safe, and can often be done on an outpatient basis with good results 7.

Pharmacologic Prevention

Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing the risk of hematoma formation following breast surgery. Both intravenous and topical TXA have been associated with lower rates of postoperative hematomas, with no increased risk of thromboembolic events in carefully selected patients 8 9.

Interventional Radiology

In rare cases of ongoing, uncontrolled bleeding (often in patients on anticoagulation), interventional radiology techniques such as angiography and embolization can successfully control hemorrhage and stabilize the patient 1.

Special Considerations

• Vasovagal symptoms related to large hematomas may respond better to early evacuation and parasympatholytic medications than to traditional treatments for hypovolemic shock, such as fluids and vasopressors 2.
• Implant-related hematomas may require implant removal or replacement, especially if infection or capsular contracture is present 4 5 6.

Conclusion

Breast hematoma is a multifaceted condition that can result from surgery, trauma, medication use, or occur spontaneously. Recognizing its symptoms and understanding the various types and causes are crucial for effective management. Treatment options have expanded to include both traditional and minimally invasive techniques, while prevention—especially in surgical settings—is increasingly possible with agents like tranexamic acid.

Key Takeaways:

• Symptoms include swelling, pain, discoloration, firmness, and—less commonly—systemic signs like hypotension and vasovagal responses 1 2 3 4 5 10.
• Types are classified by timing (acute, late), location (intracapsular, extracapsular), and etiology (spontaneous, traumatic) 3 4 5 6 10.
• Causes range from surgical procedures and trauma to anticoagulation, implant complications, and spontaneous events 1 3 4 5 6 7 8 9 10.
• Treatment depends on severity, ranging from observation and minimally invasive drainage to surgical evacuation, pharmacologic prevention, and interventional radiology 1 3 5 6 7 8 9 10.

By staying informed and vigilant, patients and clinicians can work together to manage breast hematoma effectively and reduce the risk of long-term complications.