Bruise on Breast: Causes and Treatments

A bruise on the breast can be caused by localized bleeding from small blood vessels, such as capillaries. However, bruising on the breast can also be caused by a hematoma, a pooling of blood that results from injury to larger blood vessels.

Bruises are generally flat and tender to the touch, whereas hematomas can be raised, hard, and painful. Although not cancerous, a hematoma could possibly be alarming to feel, as it may feel like a lump in the breast.

This article will review the symptoms associated with a breast bruise or hematoma, as well as how they are diagnosed and treated.

Symptoms

Bruises are generally flat and can turn the skin a dark purple color. As they fade over time, they can change to a yellow, green, or light brown color. Bruises may be accompanied by other symptoms such as:

• Mild swelling
• Tenderness

Hematomas, which are larger bleeds, can cause a hard and tender mass. The pooled blood may cause inflammation and swelling. The skin above a hematoma can appear to be bruised and, in the case of surgery, broken.

When feeling a hematoma, it may feel like a firm lump beneath the skin. That can be frightening if you're familiar with the common symptoms of breast cancer.

Causes

A breast bruise or hematoma can happen to anyone regardless of age or menopausal status. They can be caused by trauma or from medical procedures, like a breast biopsy or breast surgery. Most of the time, you will recall an injury that caused it.

Hematomas are generally caused by more serious trauma.

Injury

Injury to the breast, such as a sports injury, car accident, or fall can result in bruising or hematoma formation. They can also be caused by a weak blood vessel breaking in response to a bump or jolt.

Surgery

Any type of surgery on the breast can damage blood vessels and cause a bleed. These procedures include:

• Breast implant surgery (postoperative bleeding)
• Therapeutic (not cosmetic) breast surgery, such as a lumpectomy (removing cancerous or abnormal breast tissue) or mastectomy (removing the entire breast)

Biopsy

Breast biopsy, a procedure in which a sample of breast tissue is obtained surgically to determine if cancer is present or not, can sometime cause bleeding and bruising.

Certain types of breast biopsies can cause a hematoma. Although the risk is low, a common complication of a core-needle breast biopsy is hematoma formation. This risk can increase with a vacuum-assisted procedure.

Breastfeeding

People who are breastfeeding may also experience bruising on the breast or nipple. This can be caused by improper positioning or attachment. Grabbing or squeezing the breast during a feeding can also cause bruising.

Medications

Those on aspirin or blood thinners, such as Coumadin (warfarin), Eliquis (apixaban), or Xarelto (rivaroxaban) are at particular risk for bruising or hematomas.

Inflammatory Breast Cancer

Although rare, skin changes on the breast that look like bruising could be a sign of inflammatory breast cancer. This fast-growing cancer can cause the affected breast to become swollen, red, and tender. The skin may also appear pink or reddish purple.

Diagnosis

Bruising can be diagnosed on a physical exam, simply based on its appearance. Larger hematomas are usually visible on a mammogram and can sometimes look suspicious on other imaging as well. In some cases, a biopsy may be needed to diagnose a hematoma.

Mammogram

A small hematoma probably won’t be seen on a mammogram. However, if the hematoma is large enough to be seen, it will usually appear as a well-defined oval mass. If it resolves on its own, it won’t appear on your next mammogram.

Spots on mammograms that are more suspicious for cancer appear with a spiky outline. Hematomas may have some suspicious-appearing features due to scarring or how the hematoma affected the breast tissue.

Hematomas often leave behind calcifications (calcium deposits) as well, but these are large in contrast to the microcalcifications on a mammogram that raise suspicion of possible cancer.

Ultrasound

Hematomas are also found along with seromas, pockets of fluid in the breast that frequently occur after breast surgery. A breast ultrasound is often the best test for evaluating a possible seroma. It can provide detailed, high-contrast images that help healthcare providers determine if a lump is solid or fluid-filled.

Biopsy

In the case of a questionable breast mass, such as a hematoma that caused scar tissue and resembles a tumor, an ultrasound after an abnormal mammogram can detect if it is a hematoma. In some cases, a biopsy may be performed if the imaging continues to look suspicious. The pathology report can tell you whether the mass is benign (not cancerous) or malignant (cancerous).

Treatment

For mild bruises or hematomas, no specific treatment may be needed. The body will absorb the blood, and they will eventually go away on their own.

However, there are things you can do to help speed the healing process along. To reduce swelling and pain associated with an injury, try following the RICE protocol (rest, ice, compression, and elevation):

• Rest and protect the injured area.
• For the first day or two after the injury/trauma, apply an ice or a cold pack (wrapped in a towel) to the affected area for 10 to 15 minutes several times a day.
• If swelling is present, gently compress the injured area. A sports bra or compression bra may help with this process.
• Elevate the area where the bruise/hematoma is to help reduce swelling and ease discomfort.
  

After one or two days, try applying a heating pad or warm compress to the affected area. This can help the blood reabsorb.

Most bruises fade within two weeks, however, some can remain visible for months. A breast hematoma may last around four to six weeks, sometimes longer.

Larger or deeper breast hematomas may need to be surgically removed. In some cases, it is possible for a breast hematoma to spontaneously recur, particularly if you're taking blood thinners.

When to Call a Healthcare Provider

Most mild bruises and hematomas resolve spontaneously. However, larger or deeper hematomas can be problematic and may require medical attention.

Reach out to your healthcare provider if you experience:

• Bruising that lasts more than two weeks
• Frequent, large bruises
• Unexplained bruising
• A bruise that appears to be infected
• Hematoma symptoms that are severe
• A hematoma that continues to grow
  

Summary

A breast bruise or hematoma is usually caused by some form of trauma to the breast. Bruising can occur when small blood vessels under the skin leak or break. Breast hematomas are a collection of blood in the breast that result from damage to larger vessels. Although these can occur without an injury, most are due to an injury or surgical procedure.

A hematoma may show up on breast imaging, and it may need a biopsy if it appears abnormal in any way. A hematoma is not cancer, and many times no specific treatment is needed.

Mild bruises and hematomas generally heal on their own in time. If the hematoma is large or it continues to expand (bleed), it may require treatment by a healthcare professional.