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Hematoma After Mastectomy With Immediate Reconstruction An Analysis of Risk Factors in 883 Patients

Seth, Akhil K. MD; Hirsch, Elliot M. MD; Kim, John Y.S. MD; Dumanian, Gregory A. MD; Mustoe, Thomas A. MD; Galiano, Robert D. MD; Fine, Neil A. MD

doi: 10.1097/SAP.0b013e318243355f
Breast Surgery

Background Mastectomy followed by breast reconstruction presents unique circumstances, such as 2 operating teams, that may affect the likelihood of postoperative bleeding. This study evaluates risk factors for hematoma formation in patients undergoing mastectomy with immediate implant reconstruction.

Methods The charts of 883 patients (1199 breasts) who underwent mastectomy and immediate tissue expander reconstruction between April 1998 and August 2008 at a single institution were retrospectively reviewed. Demographic and operative factors and information on hematoma location were recorded. Fisher exact test, Student t test, and multiple linear regression were used for statistical analysis.

Results There were no differences in preoperative, operative, and oncologic characteristics between hematoma (n = 28 breasts) and nonhematoma (n = 1171 breasts) groups. Multiple linear regression analysis revealed no independent risk factors for hematoma formation, except an individual mastectomy and reconstructive surgeon (odds ratio, 3.58; 95% confidence interval, 1.03–12.37; P = 0.03; odds ratio, 2.54; 95% confidence interval, 1.06–6.08; P = 0.03, respectively). Most hematomas were diagnosed on postoperative day 0 or 1 (23/28, 82.1%) and found to originate from the pectoralis muscle (14/28, 50.0%) or axillary region (6/28, 21.4%).

Conclusions The risk of postoperative hematoma after mastectomy with immediate reconstruction is not affected by any measurable preoperative, operative, or oncologic factors. With no definitive risk factor for bleeding, surgeons should remain meticulous and vigilant throughout the operation. In particular, hemostasis should be focused on the chest wall musculature given its propensity for being the primary source of hematoma formation.

From the Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Received September 29, 2011, and accepted for publication, after revision, November 21, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Neil A. Fine, MD, Northwestern Plastic Surgery Associates, 676 North Saint Clair St, Suite 1525A, Chicago, IL 60611. E-mail:

© 2013 by Lippincott Williams & Wilkins