Breast bruises are typically the result of an injury and usually fade within a couple of weeks. While they are not a definitive sign of breast cancer, it’s important to monitor any changes in the affected area. Bruising can also be a sign to look out for during regular self-exams, alongside lumps and changes in skin density, texture, or rashes.
Understanding Breast Hematomas
A breast hematoma is a more severe type of bruise where blood accumulates under the skin, forming a raised, firm, and painful lump. These hematomas can take significantly longer to heal compared to regular bruises, sometimes even months. They occur when blood pools outside the blood vessel, causing more swelling and potentially a lump along with a dark, bruise-like area.
According to Richard Reitherman, M.D., Ph.D., medical director of breast imaging at MemorialCare Breast Center, hematomas often occur with more serious injuries, such as those sustained in car accidents, where the seatbelt can cause chest trauma. However, they can also result from less severe injuries, like biopsies or surgical procedures. A study in the journal In Vivo notes that hematoma is the most frequent complication after vacuum-assisted breast biopsy, occurring in 13% of cases.
In contrast, hematomas from needle biopsies occur in less than 1% of cases, according to a large study of over 5,000 women. Because hematomas can be deeper in the body, it may take a few days for one to appear on the skin surface after trauma, and pain and swelling can also be delayed.
Distinguishing Hematomas from Breast Cancer
In rare cases, a persistent bruise or hematoma may indicate inflammatory breast cancer (IBC), which typically occurs in women younger than 40, but the average age at diagnosis is around 59, according to the American Cancer Society. Janie Grumley, M.D., a breast surgical oncologist, explains that IBC often presents with redness and tenderness, though not always. The key difference is that hematomas tend to improve over time, while IBC symptoms worsen. IBC accounts for about 1% to 5% of all breast cancers.
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Breast cancer tumors usually don’t cause bruising. Sharon Rosenbaum Smith, M.D., associate chief of breast surgery at Lenox Hill Hospital, emphasizes that a raised bump with swelling and bruising after an injury is more likely a hematoma. However, if a lump persists even after the hematoma fades, it should be examined. Even then, an ultrasound may be recommended to ensure accuracy.
A case study published in the journal Cureus reported a rare instance of papillary carcinoma, a type of breast cancer comprising only 0.5% of all breast cancers, linked to a hematoma. In this case, the lack of healing in the hematoma led to the discovery of cancer. However, experts stress that hematomas do not cause breast cancer.
Risk Factors and Diagnosis
Several factors can increase the risk of developing hematomas. These include older age, vitamin C or K deficiency, liver disease, thrombocytopenia, viral infections, bleeding disorders, alcohol use disorder, and blood cancers like leukemia, lymphoma, or myeloma. Diagnosis typically involves a clinical exam, but deeper hematomas may require an ultrasound to assess the extent of the injury and differentiate it from conditions like IBC.
Treatment and Recovery
Most hematomas do not require medical intervention and heal on their own over time. However, some cases may necessitate treatment, especially if the pain and swelling significantly impact daily activities. Draining the blood from the area can provide relief in such instances. Recovery times vary, with bruises typically healing within 5 to 10 days, while hematomas can take much longer, sometimes months.
