Breast Hematoma

What is a breast hematoma?

A breast hematoma (pronounced “hee-mah-toe-mah”) is a collection of blood inside your breast. Like a bruise, breast hematomas develop following trauma to your breast. They can be superficial, under your skin or deeper in the breast tissue. Fortunately, most hematomas are temporary and eventually resolve on their own without treatment.

Who gets breast hematomas?

Hematomas can affect anyone who experiences an injury to their breast tissue. This injury can be related to trauma such as a fall, car crash seat belt injury or following a breast procedure.

They will occur more frequently in people who are on blood thinners (aspirin or other anticoagulation medications).

Is a breast hematoma serious?

Most hematomas aren’t serious and go away on their own. Still, let your healthcare provider know if you think you have a hematoma. A hematoma that’s rapidly growing needs attention urgently.

What are the symptoms of a breast hematoma?

A superficial under-the-skin hematoma will be easy to see. A hematoma occurring deeper in your breast may not show the bruise for several days.

If a hematoma appears after surgery, you’ll usually notice changes to your breast within 24 to 72 hours of the procedure. A hematoma can occur even if drains are in place.

Symptoms include:

• Discoloration that fades over time like a bruise (from dark purple/red to green to gray to yellow).
• Breast pain and/or tenderness.
• A lump that can feel spongy or firm to touch.
• Swelling.

Do breast hematomas hurt?

Hematomas can cause pain, or they may not cause symptoms (asymptomatic). If you’ve experienced breast trauma/injury within a short time before getting a mammogram, it may appear on the image. Notifying the mammography technicians of recent breast trauma before a mammogram is important.

What causes a breast hematoma?

Breast hematomas may form after trauma to breast tissue because of an injury or procedure. For example, hematomas may develop after a sports injury, fall or from the pressure from a seatbelt during a car accident. The rates of hematomas following breast procedures are low.

The healthcare provider treating you will inform you of the risk of a hematoma related to the specific procedure. These procedures include but aren’t limited to:

• Minimally invasive breast biopsies.
• Breast cancer surgeries.
• Cosmetic plastic breast procedures (such as breast reduction).

Spontaneous hematomas can occur if you have a bleeding disorder or if you’re taking blood thinners. Common blood thinners include:

• Warfarin (Coumadin®).
• Apixaban (Eliquis®).
• Rivaroxaban (Xarelto®).

Sometimes, hematomas may be associated with a presentation of breast cancer, but this is rare.

How is it diagnosed?

A breast hematoma is most often a clinical diagnosis that doesn’t require imaging. This means a provider completing a breast exam can assess a breast hematoma. Imaging is rarely used for diagnosis, but it can be used to assess the extent a hematoma is expanding. Imaging may be used if the diagnosis isn’t clear.

• Mammogram. A large hematoma may look like cancer on a mammogram, especially if there’s scar tissue near it. Scar tissue has a spiky appearance on a mammogram that looks similar to a cancerous tumor. Unlike cancer, breast hematomas are benign.
• Ultrasound. Your provider can use an ultrasound to see whether a mass is solid or filled with fluid. An ultrasound can show if there are fluid-filled pockets in your breasts, called seromas. Seromas often accompany hematomas.
• Biopsy.In the rare instance that there’s a question about whether a mass that appeared on a mammogram or ultrasound is a hematoma or cancer, your provider can take tissue samples and send them to a lab for testing.

When having a mammogram screening, it’s important to tell your provider if you were previously diagnosed with a hematoma. The scar tissue left behind from the breast tissue trauma can resemble cancer on a mammogram. It’s important that your providers understand your history as they screen your breasts for cancer.

How do you treat a hematoma on the breast?

Most hematomas can be observed and don’t require treatment. A hematoma that’s getting bigger needs to be evaluated by your healthcare provider. Contact your provider or go to the nearest ER if their office is closed.

How can I take care of myself?

Usually, you’ll be able to manage any swelling or pain from a hematoma at home.

• Use cold therapy for the first 48 hours. Applying cold to a newly formed hematoma helps reduce pain, inflammation and swelling. Apply a cold compress or ice wrapped in a towel for 20 to 30 minutes three times a day.
• Take Acetaminophen (Tylenol®). Take Tylenol for pain instead of nonsteroidal anti-inflammatory drugs (NSAIDs), which have blood thinning properties.

How long does a hematoma take to heal?

It usually takes around four to six weeks for a hematoma to disappear, but in some cases it may take months. In rare cases, it may take years for signs of it to completely fade. Have your healthcare provider assess how your hematoma is healing in case it requires treatment.

When does a hematoma need surgery?

If a hematoma is especially large and rapidly getting larger (or your breast looks like it’s getting larger) and your provider is concerned it’s bleeding, they may need to take you to the operating room to remove the hematoma and control the bleeding.

Once a hematoma is formed and stable, it can stay the same size for one to two weeks — and then slowly decrease in size.

How can I prevent a breast hematoma?

Breast hematomas aren’t usually preventable unless you’re taking blood thinners, which make you more susceptible to hematomas following a breast injury. If you’re taking a blood thinner, follow your healthcare provider’s guidance about avoiding injury to your breast.

What can I expect if I have a breast hematoma?

Your body will most likely absorb the blood in your hematoma over time.

When should I seek care?

Your healthcare provider will assess for a hematoma at the follow-up after a breast procedure. Contact your provider if you notice signs of infection:

• Worsening redness, swelling or pain in your breast.
• Drainage from the site of your incision that isn’t clear.
• Breast feels warm to the touch.
• Fever.

A note from Cleveland Clinic

Finding a breast hematoma can be alarming, especially if you’ve experienced an injury or are in the recovery phase following a breast procedure. The good news is that, like a bruise, a hematoma is just a sign of broken blood vessels. And like a bruise, it will most likely heal on its own in time. Your body does a good job managing these repairs. If you’re slow to heal or if you have concerns, your healthcare provider can help determine if an intervention is needed.