Breast Hematomas

Definition, Causes, Diagnosis, and Treatment of Breast Hematomas

Breast cancer, artwork
What do you need to know about breast hematomas?. Science Photo Library - ROGER HARRIS / Getty Images

If you've been told that you have a breast hematoma, what does that mean? What are the causes? Does having a breast hematoma increase your risk of breast cancer?

Breast Hematomas: Definition

A hematoma is a blood-filled swelling that has been caused by trauma to your breast. It is not cancerous, but can sometimes lead to inflammation, fever, skin discoloration, and may leave behind scar tissue that mimics the shape of a breast tumor.

It is usually visible on mammograms.

Appearance of a Breast Hematoma

You can usually see and feel a hematoma because it is often just below the broken skin, where blood has collected and clotted. The pooled blood may absorb bacteria and the surrounding tissue becomes inflamed, resulting in swelling. The skin above a hematoma will appear to be bruised as well as broken.

Causes of Breast Hematomas

A breast hematoma may be caused in several ways. The commonality is that most of the time you will be aware of either the injury or procedure which results in a hematoma. If a hematoma occurs without an injury, surgery, or some form of procedure, the diagnosis should be suspect as some other conditions may mimic a hematoma. Possible causes of a hematoma include:

  • Injury to the breast (sports injury, car accident)
  • Weak blood vessel breaking in response to a bump or jolt
  • Core needle breast biopsy (rare): The risk of a hematoma is roughly twice as high when a vacuum assisted procedure is used.
  • Breast implant surgery (postoperative bleeding)
  • Therapeutic (not cosmetic) breast surgery

Most hematomas are small—about the size of a grain of rice—but some can be as big as plums.

A breast hematoma can happen to anyone regardless of age or menopausal status.

Diagnosing Breast Hematomas

A small hematoma probably won’t be seen on a mammogram.

However, if the hematoma is large enough to be picked up on a mammogram, it will usually appear as a well-defined oval mass. If it resolves on its own, it won’t show up on your next mammogram, but if it was large enough to cause scar tissue or to cause breast tissue to become re-arranged (architectural distortion) it might look like a tumor with a spiky outline.

Hematoma Versus Tumors

In the case of a questionable breast mass, such as a hematoma that caused scar tissue and resembles a tumor, it is usually sufficient to do an ultrasound after an abnormal mammogram to see if there is a hematoma. In some cases, a biopsy may be done. The pathology report can tell you whether the mass is benign (not cancer) or malignant (cancer).

Management and Treatment of Breast Hematomas

Smaller breast hematomas will go away on their own, given enough time. Larger breast hematomas may need to be surgically removed. In some cases, a breast hematoma will spontaneously recur.

It's important to see your doctor if you have a large hematoma, and especially if you develop a hematoma unrelated to an injury to your breast. Both a mammogram and a breast ultrasound will likely be recommended, followed by a breast biopsy if the diagnosis is at all uncertain.

Aspirin and Hematomas

If you are using aspirin for pain relief or as a blood thinner or to prevent heart problems, you will bleed more easily. If you are injured while on aspirin, a hematoma is more likely to occur. Sometimes, a breast hematoma will occur spontaneously (without any injury) among people on aspirin and blood thinners such as Coumadin (warfarin) and heparin.

Bottom Line on Breast Hematomas

Breast hematomas are essentially a "bruise" on your breast, and most of the time the cause is fairly obvious, such as an injury to the breast or recent breast surgery. Breast hematomas can be uncomfortable, but usually, heal on their own in time.

If the hematoma is large, or if you continue to have bleeding (more common if you have been on blood thinners,) it may need to be surgically removed.

The problem often is that these hematomas, especially if they are large, can leave behind scarring. Scarring, in turn, may show up on a mammogram (often with an irregular, spiky outline) raising the concern about a possible breast cancer. Since it is sometimes impossible to differentiate scarring from a mass, or since both conditions may occur nearby each other, a breast ultrasound and possibly a biopsy may need to be done to be certain.

Sources:

Chetlen, A., Kasales, C., Mack, J. et al. Hematoma Formation During Breast Core Needle Biopsy in Women Taking Antithrombotic Therapy. American Journal of Roentgenology. 2013. 201(1):215-222.

Kaoutzanis, C., Winocour, J., Gupta, V. et al. Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthetic Surgery Journal. 2017 April 7. (Epub ahead of print).

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