Hematoma Following Biopsy Surgery

I had a partial mastectomy for DCIS  ten years ago, and had a drain tube post-operatively.  The procedure went well and I recovered with an average amount swelling and discoloration and pain.  Recently after a long period of waiting through a ton of diagnostic tests and waiting time for doctors I had two biopsies for atypical lobular hyperplasia and breast calcifications in my right breast.  The sites were large and a lot of tissue was removed below my nipple and deep in the center left. It should be noted that I have quite large breasts and a lot was removed. My surgeon told me that size of one was about a hardball size and the other about a half dollar size. When I was waking up I asked if he had put in a drain tube and he replied that that was not necessary.

About 3 hours post op I started having intense pain and noticed my breast was about twice its normal size...I am not kidding.  I called the MD on call and was told to go to the emergency room...which I did.  After having to wait in severe pain for over an hour someone finally took me into emergency. Another hour went buy and the surgeon whom I have never met, said we need to go in right away. He also said, "didn't Dr. -----put a drain in?"  I replied that he said it was not necessary.  They gave me a huge amount of morphine which promptly sent me into a semiconscious state and made me nauseas.  I was told I would need a tube in my throat for breathing and pressure held on my esophagus to reduce possible regurgitation of food I had eaten.  When I came out of surgery I was told that I had a huge hematoma that produced more than 600 ml on the operating table and drained another 220ml within a half hour.. close to a quart.  Any wonder I was wreathing in pain? He did another incision to put in a drain tube.
I have a bruise the color of scarlet that goes from my mid breast to behind my arm.  My throat is so sore I can hardly swallow, my red blood count is down and I am now on Iron supplements.  My oxygen levels were low enough that I had oxygen all evening and the next day.  I have sores in my mouth from the procedure and I am so constipated from the huge doses of morphine I ache.  I am on a regiment now that includes supplementation, pain meds, stool softeners and enemas and bed rest.

The doctor that performed the emergency procedure had to reopen both of my biopsy sites and put in a drain tube as well.  

I need to know if anyone else out there has had a similar situation.  And if any surgeons think this was proper protocol.  With a large site take like this one, isn't it expected that fluid would need to be drained off.  How can a doctor expect my body to absorb such large amounts of blood and lymph.?  My first surgeon certainly felt it was necessary. I am tired and I am angry that I had to go through this…that I am still going through this.  
M

[BhumikaMD]

Hi,

Well it is really very unfortunate about the situation you have had to face.

You need to call up your surgeon and ask him to schedule an appointment immediately. You need to tell him what happened and also ask him why a drain was not put.

Well, i want to assure you and wish that you settle down from the emotional trauma you might have been through. But, this is not the normal plan of management - a drain should have been put by your surgeon.

The complications of hematoma collection, a surgery, general anesthesia could have simply been avoided.

Do talk to your surgeon.
Do foolow up with your doctor regularly now.
Hope you do well and are back to normal soon enough.
Good luck and best wishes.

[meb5151]

Dr.Bhumika, MD


Thank you so much for your response!

I have really felt alone out here. I did make an appointment yesterday afternoon and saw my original surgeon.  I was not sure how he would respond and was ready for anything.  He was sorry that all of this happened to me and said this is very rare in his practice. When he saw the extent of the bruising he was a bit shocked. He went on to say that when he was in the site he cauterized the bleeding, then completely dried the tissue and saw no bleeding or fluid buildup, so he put in stitches and closed me up When I addressed the need for a drain tube and why he didn't use one, he responded by saying: "Oh, I never put in drains for lumpectomies."  I said; "even for large ones like mine?" he responded by saying that there is more risk of infection with a drain tube than warrants putting one in.  

He said the emergency room surgeon, who is one of the physicians in his practice, talked to him soon after the surgery and told him he didn’t see any excess bleeding from vessels inside the wounds.  There was little more said about the situation. He checked my drain and changed the bandage...and that was about it, except to tell me to leave in the drain for another three days. And come in to have it removed on Monday.  

Could the liquid have been drained off and a drain been put in during emergency surgery without my being under general anesthesia?  Any more suggestions in general?  And do you know of any articles from medical journals or research statistics that supports his particular approach to this situation regarding the risks of drain tubes?
M

.

[BhumikaMD]

Hi,

Well, the concern and response of your surgeon seems genuine.

So, if there wasnt any excess bleeding from the vessels inside the wound - where was it bleeding from? What did he say to that?

There is the option of doing such a surgical procedure under sedation and pain relief, but the best advisable option can only be decided at that particular moment.

Drains are generally put post operatively in patients to drain out collections - the chances of any infection are low if proper care is taken, the area is kept clean, regular follow ups to the doctor are done and the dressind got done by a doctor regularly.

Do let us know if you have any more doubts or queries.
Hope you are doing well now.
Wish you an early recovery.
Good luck.

[Sumdaysuun]

I recently had breast surgery, and I have been back to the surgeon twice because of the swelling and bruising.  He had asperated my breast, removing the blood, no clear liquids.  He states this is normal while the tissues heal.  In the meantime I now have massive bruising of my breast.  Very dark, which is really starting to worry me.  Yet I am being told all is normal.  What do you suggest?  

[frustratedrg]

I recently had just a stereotactic biopsy in June.  When the radiologist was done I had massive bleeding, my breast was purple for about a month and I still have a hematoma about the size of a golf ball.