Breast hematoma

[dd3410]

While doing my monthly self-exam about six weeks ago, I noticed a tan, sticky discharge suddenly coming from one duct of one nipple when I compressed the right breast's tissue.  I also discovered two somewhat rubbery lumps in the outer quadrant and one beneath the areola.  I am nulliparous, 39 years of age, with menarche at age 9.  I saw my PCP, who did a clinical breast exam and sent me for mammogram.  After mammogram, radiologist sent me for an ultrasound.  Both were reportedly "normal".  I had some slight bruising on the bottom part of my breast from the VERY-painful focused mammogram shots of the nipple.  The next evening while changing my clothes after work, I saw that the entire left half of my breast was dark purple, the skin was dimpled and there was a distinct lump that formed over the course of the evening.  When feeling the growing lump, it felt like I was popping the shipping bubble wrap (closest analogy I can manage).  I saw my PCP again the next day and he said it's "probably an organizing hematoma" and not to worry about it.  Well, it's been four weeks, part of my breast is still purple, the area of the hematoma is now hard, as is the "lump" beneath my areola I had found on my self-exam, and it's painful.  The hematoma protrudes about 0.5 to 1.0 cm from the surface of the skin, but you can feel it far down to my chest wall when examining my breast.  My sister is an ARNP and told me to get a second opinion, but the surgeon at our local breast cancer center refused to see me without my PCP's referral.  Should I continue to ignore this situation?

[CCF-RN,MSN-rf]

Dear dd3410:  Hematomas (blood filled pockets) usually occur with some type of injury or even occassionally with biopsy or other surgery. It is possible that there may be a weak blood vessel within the breast that may have even been bumped without notice. If it is a hematoma, these can take months to resolve.  Of course, without evaluation, we cannot say whether this is the case. A lump needs evaluation by a physician.  If you are concerned, seek a second opinion.  Perhaps a call to your PCP, explaining that you would feel more comfortable having a surgeon look at this, would yield you the referral you need.

[surgeon]

what you describe is nearly certainly a hematoma, because there's nothing else likely to evolve that rapidly  and in that way. However, it's never wrong to get another opinion. It seems unlikely that your primary doc would refuse to give a referral if you state clearly that you are worried and feel you need the reassurance of another opinion.