Breast trauma is relatively common. After experiencing breast trauma patients are often sent for diagnostic breast imaging to evaluate changes in the breast noticed either by the patient or primary care provider. Although soft tissue trauma can occur anywhere in the body, bruising in the breast is often concerning for patients and primary care providers, particularly if a traumatic event is not recalled.
Breast trauma most often results in a contusion (bruise), but a hematoma (blood collection within the tissue) may also develop. Sometimes the patient can remember a certain traumatic event that involved the breast tissue. Bumping into a piece of furniture, falls, and motor vehicle accidents are a few of the more common causes of breast trauma. Breast contusions that occur without recollection of any traumatic event tend to be more worrisome for patients. The breast tissue is quite sensitive, and it is not uncommon for a seemingly insignificant bump to result in a contusion and/or hematoma. Additional factors that place patients at higher risk of developing a contusion/hematoma include certain genetic clotting disorders and blood thinning medications like aspirin.
What does Breast Trauma Look Like?
Breast trauma may result in a visible bruise on the skin surface, a new lump at the site of the trauma, or a combination of both. No matter the symptoms, any new change in the breast should be evaluated by your primary care provider and likely with breast imaging. Noticing a connection between a traumatic event and new changes in the breast is helpful but not necessary for the breast radiologist to accurately evaluate the changes in your breast.
A breast contusion is evaluated with diagnostic breast imaging in the same way a new lump is evaluated. Briefly, if the patient is less than 30 years old, we start with targeted ultrasound at the site of new symptoms. If necessary, a mammogram will also be done for further evaluation. In women 30 years and older we start with a mammogram followed by targeted ultrasound at the site of the new symptoms.
On the mammogram a new contusion may not be visible, may be hidden by dense breast tissue, may look like normal breast glandular tissue, or it may look like developing cancer. As always, having older mammograms to compare with is immensely helpful. On breast ultrasound, a contusion/hematoma usually has a distinct appearance that helps differentiate it from cancer but this is not definitive.
Knowing that breast trauma occurred in the region of new imaging findings and/or the area of new breast symptoms is reassuring. Alternatively, if there is no known history of trauma the ultrasound appearance can be reassuring but not definitive. Often patients will be asked to return for a repeat ultrasound in 4-12 weeks. The patient is usually asked to return for follow up imaging at least once after the initial evaluation to ensure that the contusion is improving. Some contusions can take months to resolve as the body has to slowly reabsorb the blood which has accumulated in the tissues. We will have women come back at regular intervals only until we are comfortable that the imaging features are compatible with a hematoma and show that the hematoma is improving. We do not always perform follow-up imaging until the hematoma completely resolves as this could take many months.
A hematoma does not have the potential to turn into breast cancer, no matter how long it takes for the lump associated with the hematoma to resolve. However, it is not unheard of for a woman to feel breast cancer for the first time because her attention has been drawn to this region of the breast due to a traumatic event resulting in bruising and/or discomfort. This is the reason that we evaluate all new lumps in the breast, even when a known traumatic event has occurred. This is also the reason that we have patients return for additional ultrasound imaging to ensure that the hematoma improves. Although all signs point to contusion, we need to prove that the changes seen on the mammogram and/or ultrasound are in fact due to a non-cancerous contusion and not cancer that happened to be present in the same region as recent trauma.