A Bit About Bruises

Bruising is very common and expected following surgery. Here’s a rundown of what a bruise is, how it happens, how it heals, and what we can do to help speed up the process.

What is a Bruise?

Definition: Bruising, or ecchymosis, is the discoloration of the skin that occurs when blood vessels under the skin are damaged and leak blood into the surrounding tissue.
Relevance to Surgery: After any type of surgery, especially those involving incisions, tissue manipulation, or liposuction, bruising is very common. This occurs because blood vessels are cut during surgery. When a small amount of this blood leaks into the surrounding tissues, it can become visible as bruising.

Why Do we see Bruises after Surgery?

Surgical Trauma: Any surgery, including breast procedures, involves some degree of tissue manipulation and disruption, which can damage the small blood vessels (capillaries) in the skin and surrounding tissues.
Liposuction: During liposuction, cannulas are used to break up and remove fat. The cannulas are not selective; small blood vessels can also be injured during the process.
Incision Sites: Any incision made through the skin or tissues can lead to localized bruising.

How Long Does It Take for Bruises to Heal?

Bruises may take from 1 to 3 weeks to fully resolve, depending on both severity and individual healing factors. Healing time can vary depending on the type of surgery, the extent of bruising, age, overall health, and whether or not you follow proper post-operative care instructions.

The Healing Process of a Bruise

Blood Clotting & Breakdown: After the blood vessels rupture, the blood that leaks out forms a clot under the skin. Over time, the body breaks down the blood and reabsorbs it, which leads to the bruise fading.
Reduction of Inflammation: As inflammation decreases, the body’s immune system removes any damaged cells or tissues from the affected area, contributing to the resolution of the bruise.
Color Changes: The typical color progression from red to purple, green, yellow, and brown indicates the stages of the body’s process of breaking down and clearing the leaked blood.
Stages of Bruise Colors:
- Red (first few hours): Fresh blood has just leaked from broken capillaries. This is seen immediately following surgery.
- Purple/Blue (within 1-2 days): The blood starts to pool under the skin and becomes oxygen-depleted, creating a darker hue. This stage may last for 1-2 days.
- Green (3-5 days): The blood begins to break down, and hemoglobin (a component of blood) changes to biliverdin, which gives the bruise a greenish tint.
- Yellow/Golden (7-14 days): As the body continues to process the blood, biliverdin further breaks down into bilirubin, leading to the yellowish color.
- Brown (10+ days/end of healing): This indicates that the bruise is in its final stages of healing, and the blood is almost fully reabsorbed.

How to Heal Bruising Faster After Surgery

Rest & Elevation: Elevating the affected area can help reduce blood flow to the bruised area and minimize swelling.
Cold Compresses: Apply cold compresses in the first 48 hours post-surgery to reduce swelling and constrict blood vessels, limiting further bleeding.
Gentle Movement: Avoid strenuous activities, but gentle movement can help promote circulation, which aids in healing.
Arnica Supplements: Arnica is a natural remedy that is believed to help with bruising and swelling. Some people use arnica creams or take arnica tablets after surgery, but always check with your surgeon before using any supplements.
Hydration: Drinking plenty of water supports the body’s natural healing processes and helps flush out waste products that accumulate from the bruising.
Avoid Smoking & Alcohol: Smoking and alcohol can slow the healing process by reducing blood circulation. Smoking should be limited until four weeks post-surgery, and red wine should be avoided for 2 weeks.
Follow Post-Op Instructions: Make sure to adhere strictly to Dr. Naidu’s post-operative care instructions, which may include wearing compression garments, taking prescribed medications, and avoiding certain activities.

When Should You Be Concerned About Bruising?

Excessive or Unusual Bruising: If your bruise is unusually large or appears to be expanding, you should contact Dr. Naidu’s office for further evaluation. An answering service is available after office hours for emergent situations.

Conclusion

Bruising following any type of surgery is a normal part of the healing process. It occurs due to the trauma to blood vessels, and while it can be unsightly, it usually resolves in a few weeks with proper care. By understanding the healing process and knowing how to manage and speed up recovery, patients can feel more prepared for their post-surgery recovery.