Hematomas After Surgery

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QUESTION: With stage I cancer and after lumpectomy and radiation, I developed a large hematoma in the site five months after surgery. Can you explain?

ANSWER: The development of a new hematoma five months after completing lumpectomy and radiation can be brought on when a little blood vessel within the surgery site is reopened by bumping, heavy compressing (i.e., repeat mammograms), or vigorous caressing of the breast. (A number of little blood vessels were cut at the time of the original surgery and are closed by a suture or a heat tip.) Sometimes, when the swelling of the breast from the original surgery and radiation resolves, you can discover a resolving hematoma for the first time that had always been there. If you remain concerned, go to your surgeon for an evaluation. He or she needs to make sure that what you just noticed in your breast is, in fact, a hematoma. If there is no clear reason why it's there-that is, no trauma or problems with clotting-then your doctor might want to evaluate you further. This may include draining off the fluid, and possibly doing an imaging study-like a mammogram-right afterward to check things out. It's unlikely to be something worrisome, like recurrence of cancer. But if there is any reason for concern, your doctor might even want to take a biopsy of the area. Hopefully things will sort themselves out and improve sooner rather than later.

—Jennifer Sabol, M.D.

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