Wednesday, June 23, 2010

Acute Hematoma Seven Years Postop – an Article Review

 Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active.

There is a unique case presented in the Canadian Journal of Plastic Surgery of an acute, symptomatic hematoma occurring 7 years postoperatively.  Most unique is the well defined mechanism of injury which caused the hematoma.
For background, the article reminds us that hematoma formation is a complication of augmentation mammoplasty whether for cosmetic or reconstructive purposes.  Most of these will occur in the immediate postoperative period.  The incidence is reported to range from 2-10.3% in this immediate postoperative period.
In their review of the literature, the authors found only 20 cases reported to have occurred in the late postoperative period.  Most of these cases did not have a definitive mechanism of injury or develop symptoms immediately after the triggering event.
In contrast, their patient presented with both a known and traceable cause of her bleed and with symptoms that developed immediately after the initial event.
The patient was a 53 year old female who had undergone a right mastectomy with reconstruction using a saline implant seven years previous to this injury. 
The patient reported having right breast soreness after performing vigorous stretching exercises.  The following morning, she noted increased pain and bruising over the medial aspect of the breast.  She underwent right breast ultrasound in the clinic that demonstrated a small fluid collection between the anterior surface of the implant and the overlying tissue, which was of unclear consistency…..A magnetic resonance imaging scan confirmed both intracapsular and extracapsular hemorrhage.
The patient was taken to the operating room; on entering the capsule, a pool of dark red blood was visualized and 200 ml of clot was removed…..

Interesting case review.

Acute symptomatic hematoma with defined etiology seven years after breast reconstruction: A case report and literature review;
Canadian Journal of Plastic Surgery, Summer 2010, Volume 18 Issue 2: e 27-e 29; AK Seth, JY Kim
Late Hematoma after Augmentation Mammaplasty Apparently Due to Myoelectrostimulation; Cagli, Barbara; Vulcano, Ettore; Marangi, Giovanni Francesco; Cogliandro, Annalisa; Persichetti, Paolo; Plastic and Reconstructive Surgery. 119(1):439-440, January 2007; doi: 10.1097/01.prs.0000233618.94269.d4
Local Complications after Cosmetic Breast Augmentation: Results from the Danish Registry for Plastic Surgery of the Breast; Hvilsom, Gitte B.; Hölmich, Lisbet R.; Henriksen, Trine F.; Lipworth, Loren; McLaughlin, Joseph K.; Friis, Søren; Plastic and Reconstructive Surgery. 124(3):919-925, September 2009; doi: 10.1097/PRS.0b013e3181b0389e

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