Difficult healing

Bleeding is a common complication within the first 24-48 hours. In performing surgery we must cut the blood-vessels too. First we burn the vessel together at two close together points with special electric tweezers (this is called coagulation: almost sealing the opening of the vessel similar to welding).

We make the incision between the seals. This procedure should prevent bleeding during the surgery. However, it can happen that after the closure of the wound, these vessels may open and bleed causing haematoma. If this bleeding is small the vessels soon coagulate and the haematoma is absorbed. However, heavy bleeding may cause swelling and tightening; we cannot count on the excess being absorbed. In this case the wound should be opened, the clot removed, and the source of the bleeding closed.

Haematoma can be the source of several problems:

Bleeding pressing the tissues is a serious problem in closed areas; the consequent swelling constricts blood vessels and circulation becomes slower. Oxygen and nutrients may be unable to reach bodily cells and excreta and poison accumulates. This leads to skin and tissue necrosis. If the haematoma is not too large, then it may not be necessary to remove it, but it can still be a danger due to the risk of infection. Sometimes this may lead to capsule formation with breast implants. However, if we open the wound again the possibilities of infection are obviously greater.

There can be borderline cases, when it is difficult to determine whether it is better to remove the clot risking further surgery, or to wait and see if it is absorbed naturally. Either choice could involve a level of risk. The surgeon must decide what he believes to be the safest path on an individual basis.