Breast reconstruction is a major surgery that requires a lot of healing. After all, a large area of your chest has been surgically altered. It makes sense to have some swelling, bruising, and soreness while you heal.
Sometimes, fluid or blood can collect under the skin during that healing process. When you’ve already been through cancer treatment, every symptom can seem extra worrisome.
Some swelling after surgery is normal, but there are moments where it can and should cause concern. Two possible causes of worrisome swelling after surgery are a seroma or a hematoma. A seroma is a collection of fluid under the skin; a hematoma is a collection of clotted or partially clotted blood.
You are the expert on your body. More information on seroma and hematoma can help you determine when to be concerned so that you can get the care you need.
What is a seroma?
A seroma is a pocket of clear or yellowish fluid that builds up under the skin after surgery. That fluid can include plasma (the liquid part of your blood) and lymphatic fluid (also called lymph).
Seromas are especially common after breast reconstruction surgery because tissue was moved, removed, or lifted. That leaves a lot of spaces where fluid can build up. Seromas can happen after many different types of breast reconstruction, including if you’ve had implants or tissue expanders placed, or if you’ve undergone a natural tissue reconstruction.
Preventing a seroma after breast reconstruction
Fluid buildup is a normal part of post-op recovery; its removal is critical. Seromas form when there is no way for the fluid to leave the body. After breast reconstruction, your surgeon may place closed-suction drains to create a pathway for fluid removal. These small surgical devices draw fluid out of the body. Typical drains consist of a thin, flexible tube that is placed under the skin with an attached squeeze-bulb at the end. The bulb has a removable plug, which is used to drain fluid from the bulb and to create suction.
Closed-suction drains are not infallible. Even with proper post-op care, seromas can develop in some patients. If you find yourself among them, take a deep breath. This is a known complication that your surgical team has handled many times before.
What is a hematoma?
A hematoma is a pocket of blood that collects under the skin or around the surgical area.
After breast reconstruction, a hematoma can happen when bleeding happens in the surgical site. It may cause swelling, bruising, firmness, pain, or pressure. The skin may look red, purple, blue, or very bruised.
Small hematomas may improve on their own. Larger hematomas, on the other hand, can be more serious. A hematoma that is growing, painful, or causing pressure on the breast, implant, tissue expander, flap, or incision likely needs medical attention.
Preventing a hematoma after breast reconstruction
It is important to follow your post-op guidance and check in with your surgeon, as proper post-op care reduces the risk of developing a hematoma. However, like seromas, hematomas are not always preventable. Your surgical team might use a medicine called tranexamic acid to reduce the risk of hematomas. But overall, there isn’t much you can do.
Seroma vs hematoma: How to tell the difference
The chart below can help you understand some of the differences between seromas and hematomas after breast reconstruction surgery. One key difference is bruising; redness, purple or blue color, or other changes to skin color typically point to a hematoma. While you are the expert on your own body, you may not be able to tell the difference by yourself. That’s why you have a dedicated team of healthcare providers. It’s always safest to call your surgical team if you notice new swelling, increasing pain, or a change in how the breast looks or feels.
| Feature | Seroma | Hematoma |
| Appearance | Swelling or fullness; skin may look normal since the fluid is clear | Swelling with bruising, redness, purple/blue color, or darker skin changes |
| Symptoms | Soft, squishy, or fluid-filled | Firm, tight, painful, or pressure |
| When it may happen | Often develops days to weeks after surgery, especially after drains are removed | Often happens soon after surgery |
| Pain level | May be painless or mildly uncomfortable | Often more painful, tight, or tender than a seroma |
| Main concern | Fluid buildup, infection risk, delayed healing | Bleeding, pressure, infection risk, delayed healing |
| Possible treatment | Watching closely, the fluid may reabsorb on its own, or drainage by your surgical team | Close evaluation, blood may reabsorb on its own, may need drainage or surgery if large or worsening |
How common are hematomas and seromas after breast reconstruction?
Both hematomas and seromas are known complications of breast reconstruction, but seromas are more common. Some studies estimate that seromas develop in 40% of breast implant surgeries.
Hematomas are also something your surgical team will warn you about, but they occur much less often; estimates suggest that they happen in about 2.5% of cases.
When to call your doctor or go to the emergency room
You know your body best. If something feels off, take action.
Call your surgeon or breast reconstruction team if you notice:
- New swelling, fullness, or a lump near the breast, chest, incision, or underarm area
- Swelling that is getting bigger, feels tight or uncomfortable, or is not improving
- Increasing pain, redness, warmth, or tenderness
- Cloudy, pus-like, bloody, or bad-smelling drainage from the incision
- Fever, chills, or feeling generally unwell
- A sudden change in drain output, very bloody drain fluid, a drain that stops working, or a drain that falls out
Go to the emergency room or seek urgent medical care if you have:
- Sudden, fast swelling of the breast
- A breast that quickly becomes much larger, tighter, or more painful
- Heavy bleeding or bleeding that will not stop
- A large amount of bright red drainage
- Dizziness, fainting, weakness, confusion, chest pain, or shortness of breath
- Skin that becomes very dark, black, blistered, numb, or extremely painful
- After flap reconstruction: sudden swelling, severe pain, major color change, or a breast that becomes very firm
