Author Topic: After Gynecomastia Surgery Forum - Hematoma Complication Questions  (Read 10629 times)

Offline DrBermant

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Hi Doctor,

Seven days ago I had bilateral gynecomastia surgery done to remove a small amount of breast tissue. Everything went well during the surgery and three hours later I was home, feeling fine, as if I had not had a surgical procedure just a few hours before. But on the same night after the surgery, I developed significant bruising and swelling on my right breast. I called my doctor and he said he wanted to see me in the morning. When he saw me in the hospital, he said it was a hematoma. He gave me a detailed explanation about what it was and how it could be treated.
He then elected to manage the hematoma on surgically, which means that I had another operation to remove the clotted blood trapped under the skin. It has been six days since the second surgery and my right breast is still swollen, bruises all over it, it is larger than the left one and there is a hard, lumpy mass on it, right under the nipple area.
Here are my questions:
1.            Is it normal to have this lumpy mass, even after I had all the clotted blood cleaned out (surgically, when the hematoma was opened, drained and no bleeding source was found).
2.            Can this lumpy mass under the areola be a big scar from a resolved hematoma?
3.            After the hematoma removal, the consistency of the empty area (where the clotted blood was) was not supposed to be “jelly like” as I thought it was going to be?
4.            Is this firm something to be expected? I mean, is it the typical course of events after development of a hematoma following a gynecomastia surgery?
5.            Can it be more blood (or any other fluid) re-accumulating? Or just remaining of clotted blood that will eventually liquefy by itself?

Thank you,


This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.



Gynecomastia Surgery, LIke Any Surgery Can Have Complications. That is the risk of any activity. Such issues were part of the education process for my patients and should be part of any good surgeons consultation about risks benefits, and alternate methods of care.

I have already answered most of your questions in this prior post Gynecomastia Surgery Forum - Had Hematoma & at 3 Months Look Same As Before:

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I had b/l reduction mammoplasty 3 months ago for mild to moderate gynecomastia, with drains kept in place,
removed 3 days after the operation. The problem is, I look exactly the same as I did pre-operatively. The surgeon told me that there are "organizing hematomas" underneath, which should re-absorb over time. This doesn't make sense to me. How can you cut out tissue from under the skin and then have the outer appearance look exactly the same as it did before having it cut out? Is this guy a moron?

Hematoma complications after gynecomastia surgery or a collection of blood is in itself an additional injury the body must heal itself from. The body must dissolve the blood and then absorb all of the products. This process extends the recovery process from swelling and bruising. The additional time can range from weeks to months. Eventually, the resorption process stops.

Sometimes the remaining elements become a contributing component for the Residual Puffy Nipple Complication I named for the many patients coming to me unhappy with surgery done elsewhere. This contour may yet resolve. When it does not then revision surgery becomes an option. My Standard After Gynecomastia Pictures methodology was developed to demonstrate and document such issues after surgery. Follow the instructions carefully if you want others to better understand your concerns.

Although there hematoma do tend to improve, many just do not. It is a question of just how much someone is willing to accept deformity after surgery. Replacing a small amount of gland with a similar or larger volume of scar from resolved hematoma is not a success story. Unfortunately I see many patients unhappy after surgery done elsewhere with such deformities after surgery that are quite visible in person or with the standard documentation I just described.

The best way to deal with hematoma is not to have them in the first place. Something that is best approached for a passion to minimize bruising, bleeding, and swelling after surgery. My photographic documentation of my patients' progression of healing after surgery has permitted me to analyze my techniques and evolve them over the years such that hematomas are quite rare in my practice, but they can happen. Although no doctor can promise no risk for this complication, lowering the chances are a reasonable and achievable goal.

The main point is how much Bruising with Gynecomastia Surgery can be minimized by methodology. Examples shown are typical for my patients. You can see many other examples on my site. Less bruising means less swelling and can translate to a faster recovery. Not all doctors show how their methods evolve after surgery. Sometimes you can get a glimpse on a forum like this.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

There are additional details on this post: Brazil Gynecomastia Forum - Hematoma Drained - What to Expect? Can I Send Photos

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Here are my questions:
1.            Is it normal to have this lumpy mass, even after I had all the clotted blood cleaned out (surgically, when the hematoma was opened, drained and no bleeding source was found).

Typically it is quite rare to find a bleeding source for any hematoma unless the problem is evaluated shortly after the bleeding starts. Yes, such collections can occur in the operating room during surgery itself, when there is the greatest chance of actually seeing the problem, solving it, and achieving the best result removing the blood before it permeates throughout the tissue planes causing bruising. Drainage typically removes as much excess blood collection as possible. However, it does not address blood that has stained or migrated as any bruise evolves.


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2.            Can this lumpy mass under the areola be a big scar from a resolved hematoma?

See answer above about Puffy Nipple Complication where excess firmness tissue can be residual gland, scar, or resolved hematoma (a scar in of itself).


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3.            After the hematoma removal, the consistency of the empty area (where the clotted blood was) was not supposed to be “jelly like” as I thought it was going to be?

The term “jelly like” applies to the the consistency of clotted blood. Normal tissue in the male chest does not have that consistency.

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4.            Is this firm something to be expected? I mean, is it the typical course of events after development of a hematoma following a gynecomastia surgery?

Please see prior posts above for answer. 


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5.            Can it be more blood (or any other fluid) re-accumulating? Or just remaining of clotted blood that will eventually liquefy by itself?

Hematoma can recur. That is why I preferred closely monitoring the rare hematoma complications I saw. The liquefaction process is how the body breaks down blood, dissolving it to be absorbed.

Prevention, again, is the best option. That is why I was so meticulous with my surgical technique and stress patient education so heavily to minimize such issues.

You are welcome to join our discussion, share your experiences and help others by explaining what happened. Posting pictures can help track the current problem and how tissues evolve over time. A few views are just not enough to show the details needed. That is why I evolved my Standard Pictures for Revision Gynecomastia Surgery which picks up subtle problems. Posting sequential photographs can track improvement or loss of progress. Even more critical for movement are Standard Gynecomastia Videos

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Revision Gynecomastia and Chest Surgery
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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