We commend the authors on their accumulation of data regarding the incidence of breast hematoma following cosmetic breast augmentation and welcome their insightful discussion. The incidence of breast hematoma in their accumulated data is similar to our concluded incidence of breast hematoma associated with prosthetic breast implantation. The incidence of breast hematoma in their population of cosmetic breast augmentations was 2.5 percent. The incidence of breast hematoma at our center was 1.65 percent of all patients undergoing procedures involving prosthetic breast implantation, without any measured statistical difference in incidence between cosmetic and reconstructive procedures.1 In addition, in our review of the literature, the incidence of breast hematoma following similar procedures ranged from 1.0 to 12 percent, with an average incidence of 2.3 percent in a cumulative 6542 patients.2-9
All hematomas identified during the study period were included, to reduce selection bias. Patients identified with breast hematoma later were more likely to present with either a palpable swelling about the implant that was evacuated in a nonemergent manner or identified incidentally in the operating room during a second procedure. Although we did not identify any emergent late hematomas, such hematomas are reported in the medical literature even in the absence of obvious trauma or anticoagulation and years after the procedure.10,11 Although breast hematomas are exceedingly rare beyond 1 month after the procedure, hematomas do still occur. Because of the rare nature of these hematomas and without adequate knowledge of the incidence of spontaneous hematoma in the unoperated breast, an assessment to implicate the breast prosthesis cannot be engaged.
Patient follow-up varied somewhat between the surgeons included in our study, but typically included a follow-up at approximately day 2, day 14, and week 8. Hematomas could have been identified in any of the following settings: postanesthesia care unit, emergency department, plastic surgery clinic, or the hospital’s associated non–plastic surgery clinics. Ten of the 21 emergent hematomas were identified by the first postoperative day; six of these were identified on the day of operation either in the postanesthesia care unit or in the emergency department. The average interval of 37 days following the procedure results from inclusion of three breast hematomas identified greater than 30 days from the procedure. These were identified at days 84, 229, and 652. Exclusion of these patients results in an average interval of 7.7 days. We have no additional insight regarding timing of presentation of hematomas between ours and other data sets beyond speculation.
The authors have no financial interest to declare in relation to the content of this communication.
James B. Collins, M.D.
Charles N. Verheyden, M.D. Ph.D.
Department of Surgery
Division of Plastic Surgery
Scott & White Healthcare
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