Medical Oncologist
After your operation
Haematoma and bleeding after breast surgery
A haematoma is blood collecting in the space where tissue was removed. Unlike a seroma it appears quickly, feels firm rather than squashy, and is often painful. A swelling that comes on over hours needs to be seen the same day. This page explains how to tell it apart from bruising, and how it is treated.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
What is a haematoma, and how urgent is it?
A haematoma is a collection of blood in the space where tissue was removed. Unlike a seroma, it usually appears quickly, feels firm rather than squashy, and is often painful. A swelling that comes on over hours needs to be seen the same day.
How it differs from ordinary bruising
Bruising is blood spread thinly through the tissues. It looks dramatic, travels downwards with gravity and is harmless. A haematoma is blood pooled in one place, so it forms a distinct firm lump and makes the area feel tight.
Why speed matters here
A small haematoma is left alone and reabsorbs. A large or expanding one presses on the wound, raises the infection risk, and occasionally needs returning to theatre to find and stop the bleeding point. Caught early it is a much smaller problem.
When it usually happens
Most appear within the first day or two, which is why you are watched closely after surgery. Later ones are less common and are sometimes linked to blood thinners, straining, or a knock to the area.
Swelling that is increasing over hours, with tightness and pain, is a same-day call. Do not wait overnight.
!
Ring the ward immediately
Contact the hospital straight away if swelling is visibly increasing over minutes or hours, if the breast or chest feels rapidly tight and hard, if bleeding soaks through a dressing, if the skin over the area looks stretched, shiny or is turning dark, or if you feel faint, clammy or your heart is racing. This is one of the few genuinely urgent complications after breast surgery, and it is treated easily when reported at once.
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Ask an oncologistSide by side
Bruising, seroma and haematoma
What you notice
What it usually is
Purple staining spreading downwards, not raised
Ordinary bruising. Harmless, fades over weeks
Soft squashy swelling, skin normal colour, painless
Seroma. Can wait for clinic
Firm tight lump appearing over hours, painful
Haematoma. Same-day assessment
Red, hot, increasingly painful, with fever
Infection. Same-day assessment
Firm lump weeks later, skin normal, not growing
Usually scar tissue or fat necrosis. Get it checked
What is done
How a haematoma is managed
The size and whether it is still growing decide everything.
Observation
A small, stable haematoma is left to reabsorb, which takes weeks. You will be reviewed to make sure it is shrinking rather than growing, and told what to watch for.
Pressure and review
A firm dressing or supportive bra, with a check within a day or two. This is common for a moderate collection that has clearly stopped enlarging.
Ask when you will be reviewed, and by whom.Return to theatre
For a large or expanding haematoma. The wound is reopened, the blood removed and the bleeding point stopped. It is a short operation and the relief is usually immediate.
Checking your clotting
Blood tests, and a review of any blood thinner you take. Sometimes a haematoma is the first sign that a medicine needs adjusting.
Tell them about
- Aspirin or other blood thinners
- Herbal preparations and fish oil
- Any family bleeding tendency
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Words you will hear
The vocabulary, in plain language
- Haematoma
- Blood pooled in one place under the wound, forming a firm lump.
- Evacuation
- Returning to theatre to remove the collected blood and stop the bleeding point.
- Expanding haematoma
- One that is still growing. The situation that needs urgent attention.
- Ecchymosis
- The medical word for ordinary bruising spread through the tissues. Harmless.
- Compression dressing
- A firm dressing or supportive bra applied to limit further bleeding.
- Fat necrosis
- Fat that has lost its blood supply and formed a firm lump. A later cause of lumpiness, and harmless.
Being straight with you
What it means, and what it does not
A haematoma is a recognised complication of surgery, not evidence that anything was done badly. Small vessels can open up after the operation as blood pressure returns to normal or when you cough or strain, and that is not predictable.
It does not affect your cancer outcome
Removing the blood does not disturb the cancer surgery or change your pathology result. What it can do is delay the start of chemotherapy or radiotherapy while the area settles, which is the practical argument for getting it treated quickly.
Returning to theatre is not a disaster
Families hear this and assume something has gone seriously wrong. It is a short operation, often under half an hour, and most women feel considerably better immediately afterwards because the tightness is relieved.
Ask what to watch for once you are home
Before discharge, ask exactly what would make them want to see you again and who to ring out of hours. A haematoma treated at once is a short procedure; the same collection left overnight is a longer one. Knowing the threshold in advance is what makes an early call easy rather than an imposition.
Some bruising will still appear
Even after a haematoma is treated, the blood already in the tissues has to resorb. Expect dramatic-looking bruising that travels downwards and changes colour over two or three weeks. That part is normal and needs nothing.
Commonly believed
What families assume about bleeding after surgery
All that bruising means something went wrong.
Bruising after breast surgery is expected and often looks alarming, spreading downwards with gravity as far as the abdomen. What matters is not the colour but whether there is a firm, tight, growing lump underneath it.
We should wait until morning rather than disturb anyone.
An expanding haematoma is one of the few genuinely urgent problems after breast surgery. Wards expect these calls at night and would far rather hear from you early. Waiting turns a short procedure into a bigger one.
Going back to theatre means the surgeon made a mistake.
Small vessels can start bleeding again after the operation as blood pressure returns to normal or when you cough. It is a recognised complication rather than an error, and it is dealt with in a short procedure.
Massaging the lump will disperse it.
Do not massage or press a firm swelling after surgery. It can restart bleeding and it will not break up a collected haematoma. Support the area, avoid straining, and let the team assess it.
Questions we are asked
Common questions about haematoma
How do I tell a haematoma from a seroma at home?
A seroma is soft, squashy and usually painless, with skin its normal colour, and appears gradually after the drain comes out. A haematoma is firm and tight, often painful, and appears quickly, usually in the first day or two. If it came on over hours, treat it as the second and ring.
Will I need another operation?
Only if it is large or still expanding. Many are observed and reabsorb on their own over several weeks. If theatre is needed it is a short procedure, and most women feel much more comfortable immediately afterwards once the pressure is relieved.
Does it delay chemotherapy or radiotherapy?
It can, by a short period while the area settles and any wound problem resolves. Treated promptly the delay is usually small. This is the practical reason your team wants to hear about it quickly rather than at your next appointment.
Was it caused by my blood thinner?
Sometimes, which is why the plan around stopping and restarting them matters so much. Never stop or restart one yourself. Your team will review the timing and may adjust it before you start again.
Can I put ice on it?
Ask your team first. Ice is sometimes advised early to limit swelling, but the skin over a fresh wound can be numb and is easily damaged by cold. Never apply ice directly, and never to a reconstruction without specific advice.
How long until the bruising fades?
Usually two to three weeks, changing through purple, green and yellow as it resorbs, and travelling downwards. That progression is normal. What is not normal is new swelling appearing once it had settled.
Will it affect how my scar looks?
A large haematoma can stretch the tissues and occasionally leaves a firmer or more uneven area. Scars keep improving for a year or more. If the result still bothers you once healing is complete, ask what can be done.
Can I still do my shoulder exercises?
Ask before continuing. Gentle movement is usually still encouraged, but vigorous stretching may be paused briefly while a haematoma settles. Do not simply stop everything, as stiffness sets in quickly and is harder to reverse.
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Sources
- Cancer Research UK — Problems after breast cancer surgery
- National Cancer Institute — Surgery to treat cancer
- Breast Cancer Now — Recovering from breast surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.