“Although the risk of postoperative bleeding is inherent to all surgical subspecialties, the development of a hematoma after mastectomy with implant reconstruction involves unique risk factors, including the routine involvement of 2 distinct surgical teams. However, despite numerous studies reporting their outcomes following these operations, a rigorous analysis of individual andcoperative factors that contribute to postoperative hematoma formation
has never been documented.”

“The postoperative hematoma continues to be a ubiquitous, and seemingly unpredictable, surgical complication. Nevertheless, mastectomy with immediate breast reconstruction presents unique intraoperative circumstances that may influence its likelihood. For example, tumescent mastectomy technique, used by breast surgeons to clarify dissection planes while potentially reducing perioperative pain and intraoperative blood loss, may increase hematoma rates as its vasoconstrictive effects subside postoperatively. Expander-pocket
irrigation with a local anesthetic solution containing ketorolac has also been shown to reduce postoperative pain requirements, although its effect on postoperative hemostasis in this setting is unclear.”

Seth AK, et al Hematoma after mastectomy with immediate reconstruction: an analysis of risk factors in 883 patients. Ann Plast Surg. 2013 Jul;71(1):20-3.