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Nurses play an instrumental role in the early detection of postoperative hematomas. The importance of nurse education regarding signs and symptoms of hematoma formation in patients during postoperative recovery is discussed.
Several reconstructive options are available after mastectomy for breast cancer. A patient can elect to have no reconstruction, implant-based reconstruction, or reconstruction with autologous tissue (Homsy et al., 2018). Incidence of postoperative breast hematoma is 0%-9%, with slight discrepancies based on the type of breast surgery performed (Gupta et al., 2017; Mikhaylov et al., 2018; Offodile et al., 2019). This complication often requires return to surgery for hematoma evacuation. Delay in detection and evacuation of hematoma can lead to additional unfavorable sequelae, such as compromise to the overlying skin or failure of reconstruction (Phan et al., 2020). Because nurses perform critical postoperative breast assessment, their education on identification of postoperative hematoma formation is critical. This case describes a near-miss postoperative breast hematoma, highlighting the critical role nurses play in patient care and the importance of identifying and addressing knowledge gaps to improve that care.
Case Description
The patient is a 49-year-old female with a history of May-Thurner syndrome characterized by hypercoagulability. Eight years before presentation for breast cancer, she developed deep venous thrombosis that required bilateral common iliac vein stent placements, as well as chronic anticoagulation with aspirin 81 mg daily and apixaban (Eliquis®) 5 mg twice daily. After diagnosis with left breast estrogen receptor positive/progesterone receptor positive, human epidermal growth factor receptor 2 negative invasive lobular carcinoma, the patient was offered left skin-sparing mastectomy with sentinel lymph node biopsy combined with immediate implant-based breast reconstruction. To achieve symmetry, the right breast was to be reduced at the same time. Pre-operatively, she was counseled to stop aspirin and apixaban 1 week and 3 days before surgery, respectively. Due to the high risk for clot formation, she was bridged with enoxaparin (Lovenox®) until 1 day before surgery. She underwent the procedures as described (left skin-sparing mastectomy with sentinel lymph node biopsy, left immediate reconstruction with tissue expander placement, right breast oncoplastic reduction for symmetry). At 3:26 a.m. on postoperative day 1, the following electronic page was received by the on-call plastic...