Case Report of Spontaneous Hemorrhage 13 Years After Breast Augmentation

Abstract

The case of a delayed spontaneous bleed 13 years after an augmentation mastopexy is presented. The patient underwent exploration of the breast pocket, hematoma evacuation, implant extraction, vessel ligation, and skin closure without immediate reimplantation. Early complications of breast augmentation include hematomas in 1% to 10% of cases. Late complications include capsular contracture, implant deflation, implant rupture, and rarely delayed bleeds. There are various theories regarding the pathophysiology of late hematomas to include erosion of pericapsular arteries, capsular microfractures, and chronic inflammation. Theories regarding the pathogenesis of capsular contracture are discussed using literary evidence that highlights an association between capsular contracture and capsular bleeding. Evidence discussed includes recurrent bleeds, progression from class 1 to class 4 Baker Contractures, and bilateral capsules with thicker capsules on the side having bleeding. Similar processes seen in other specialties like adhesion formation after gynecologic procedures are seen. In conclusion, delayed spontaneous bleeding after breast augmentation is rare, imaging and prompt exploration should follow, and consideration should be given to capsulectomy.