Efficacy of Tranexamic Acid in Reducing Seroma and Hematoma Formation Following Reduction Mammaplasty

Predictors of seroma after breast reduction: When should drains be considered?

BACKGROUND

The use of drains in reduction mammoplasty is highly variable among plastic surgeons. However, there is limited evidence to guide surgeons on the optimal timing and conditions for using drains to reduce the risk of seroma formation. The objective of this study was to identify factors that predict the possibility of developing postoperative seroma formation.

METHODS

Retrospective review of patients who underwent bilateral reduction mammoplasty without intraoperative drain placement at our institution between January 2016 and July 2021 was performed. Demographics, clinical characteristics, and the rate of seroma that required aspiration or drainage were recorded. Univariate time-to-event analyses using Cox regression were performed to identify the predictors of seroma.

RESULTS

A total of 234 patients (468 breasts) were included. The mean age, body mass index, and resection weight were 40.9±17.6 months; 30.7±5.5 kg/m2, and 717.2±388 g, respectively. The superomedial pedicle was used in 268 (57.3%) breast reductions while the inferior pedicle was used in 200 (42.7%) cases. Median follow-up time was 3.2 months (IQR: 2.8 months). Seromas occurred in 17 breasts (3.6%). Patients who were of World Health Organization Obesity Class I (hazards ratio, HR = 15.5, p = 0.01), Class II (HR = 13.9, p = 0.016), and Class III (HR = 27.4, p = 0.004) had increased risk for developing seroma when compared to non-obese patients.

CONCLUSIONS

The rate of seroma formation was 3.6% in this cohort. Obesity significantly increased the risk of postoperative seroma formation that required aspiration or surgical drainage; therefore, surgeons who aim to further reduce the risk of seroma should consider using drains for these patients.

Tranexamic Acid for Postoperative Outcomes in Breast Plastic Surgery: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES

Tranexamic acid (TXA), a synthetic antifibrinolytic agent, offers considerable promise as a potential therapy to improve postoperative outcomes for patients undergoing breast surgery. However, its specific role in plastic breast surgery remains understudied. Hence, we aimed to evaluate its efficacy in cosmetic plastic breast surgery.

METHODS

An extensive literature search of electronic databases such as PubMed, Embase, and Cochrane CENTRAL was conducted from inception to October 2023. Quality assessment of the included studies was done using the Newcastle-Ottawa scale (NOS). The results of our analyses were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled using a random effects model. A p-value < 0.05 was considered significant in all cases.

RESULTS

A total of 8 studies, encompassing 2311 participants were included in our analysis. The pooled analysis demonstrates that TXA is associated with a significant improvement in hematoma formation (OR 0.37, 95% CI: 0.24-0.58; p < 0.0001). There was no significant improvement in seroma formation (OR 0.65, 95% CI: 0.33-1.27; p = 0.21), infection rate (OR 1.84, 95% CI: 0.49-6.94; p = 0.37) or partial loss of the nipple-areolar complex (OR 0.47, 95% CI: 0.12-1.82; p = 0.28).

CONCLUSION

Tranexamic acid demonstrated considerable efficacy in improving postoperative outcomes for patients undergoing cosmetic and reconstructive breast surgeries.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Role of tranexamic acid (TXA) in plastic and reconstructive surgery: A national perspective

PURPOSE

Despite the widespread use of tranexamic acid (TXA) in plastic surgery, guidelines for the safe and effective administration have yet to be established. The present study reports the current practices of TXA usage in plastic and reconstructive surgery procedures among members of the American Society of Plastic Surgeons (ASPS).

METHODS

An online survey was distributed to all active members of the ASPS. The survey was organized into three general parts: (1) demographic data and practice profiles; (2) familiarity, perceptions, and experience with TXA in various plastic surgery fields including craniofacial surgery, aesthetic surgery, burn care, microsurgery, and Mohs surgery; and (3) TXA dosage, mode, and time of administration.

RESULTS

Five hundred two ASPS members completed the survey (21% response rate). Among the respondents, TXA use was most common in aesthetic surgery (90.3%), craniofacial surgery (78.2%), and breast reconstruction (61.8%). The most common procedures performed under TXA were facial procedures, including facelift (83.6%), neck lift (77.1%), forehead and browlift (54.8%), and rhinoplasty (55.0%). TXA administration protocols in aesthetic procedures included IV bolus (52.3%) and topical administration (50.5%). The most common IV bolus dose was 1 g (43.2%) and the most common TXA solution concentration was 3% (36.0). A total of 92.4% of respondents reported that they had never observed any TXA-related complications.

CONCLUSIONS

The results reflect the widespread use of TXA among ASPS members, the preferred administration protocols in plastic surgery, and TXA's efficacy and favorable safety profile across a wide range of procedures.

The Impact of Tranexamic Acid Administration in Reduction Mammaplasty: A Systematic Review

BACKGROUND

Previous studies demonstrated the effectiveness and safety of tranexamic acid (TXA) in several surgical specialties. Recent publications suggested that TXA may also be beneficial in plastic surgery, including breast procedures.

OBJECTIVE

The aim of this study is to evaluate the impact of TXA in reduction mammaplasty by assessing several intraoperative and postoperative outcomes and the safety of its administration.

METHODS

A systematic search was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines on several online databases. Studies evaluating the outcomes of TXA administration in patients undergoing reduction mammaplasty, regardless of TXA dose and administration route were eligible for inclusion. Only studies with a control group were included. Risk-of-bias assessment was conducted using Cochrane and MINORS (Methodological Index for Non-Randomized Studies) tools.

RESULTS

Our systematic review included 7 studies: 3 randomized controlled trials and 4 retrospective cohorts involving 1234 female patients (2232 breasts), 741 of whom received TXA (60%). Four studies used topical TXA, 2 used intravenous (IV) TXA, one used locally infiltrated TXA, and another combined locally infiltrated TXA with IV TXA. Four studies demonstrated benefits from TXA administration, whereas 3 studies did not. Topical TXA used just before wound closure resulted in a 42% reduction in drain fluid output and a 10-times reduction in major hematoma. The administration of IV TXA during induction resulted in a 12-times reduction in major and minor hematoma. The combined use of IV and locally infiltrated TXA reduced intraoperative blood loss. No adverse effects were reported.

CONCLUSIONS

There is scientific evidence suggesting TXA may be effective and safe in reduction mammaplasty.

Tranexamic Acid in Breast Surgery - A Systematic Review and Meta-Analysis

BACKGROUND

Hematoma formation is a possible postoperative occurrence following breast surgery. It might increase the risk of long-term complications and thereby delay start of adjuvant therapy. Tranexamic acid (TXA) is suggested to decrease the risk of postoperative hematoma, but the evidence is based on small and heterogeneous studies. The primary objective of this systematic review and meta-analysis is to assess the impact of TXA on hematoma formation and secondarily on drain output, time upon drain removal, seroma formation, infection incidents, and thromboembolic events.

METHODS

A literature search was conducted in PubMed, Embase, Medline, Cochrane Library, and Google Scholar. Studies examining either intravenous or topically administered TXA were included and underwent risk of bias assessment.

RESULTS

A total of 989 studies were screened and 19 studies fulfilled the inclusion criteria. Of the 7673 breasts in total, topical TXA was given to 2106 breasts, intravenous to 1722 and the remaining 4347 breasts were controls having no TXA. Hematoma formation was significantly reduced by both topical administered TXA (RR, 0.33; 95% CI, 0.15-0.75) and intravenous TXA (RR, 0.45; 95% CI, 0.29-0.68) across all breast procedures. The same result was found when only including oncological breast procedures; topical TXA (RR, 0.16; 95% CI, 0.05-0.56) and intravenous TXA (RR, 0.50; 95% CI, 0.31-0.81). A reduction in drain output and time until drain removal was noted. No significant reduction in seroma formation was observed.

CONCLUSION

Both topical and intravenous TXA in breast surgery significantly reduce hematoma and reduce drain output and time upon drain removal. Studies show no effect on seroma formation, infection rates, or thromboembolic events.

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Length of Hospital Stay, and Postoperative Complications in Reduction Mammaplasty

Background: Reduction mammaplasty is a common, elective, and safe operation, usually executed in healthy patients. Nonetheless, postoperative complications like bleeding and seroma formation can occur and significantly complicate the postoperative course. Tranexamic acid (TXA), a commonly used antifibrinolytic drug, offers a novel approach to reduce these complications. This study aims to evaluate its effect on the rate of postoperative bleeding, drainage volume, length of hospital stay, and other postoperative complications in patients undergoing reduction mammaplasty. Method: A retrospective study on all patients undergoing reduction mammaplasty at the Department of Plastic, Reconstructive, and Aesthetic Surgery EOC between 2015 and 2022 was conducted. Patients were divided into the TXA group receiving systemic TXA for 48 h and the control group not receiving any TXA. All data were analyzed using nonparametric formulas. Results: A total of 209 breasts were included in the study, with 138 cases in the control group and 71 in the TXA group. Three cases requiring revision surgery due to bleeding were observed in the control group, whereas none were observed in the TXA group. Total drainage volume was significantly reduced in the TXA group compared to the control group (TXA: 41.6 mL vs. control: 53.8 mL; p = 0.012), resulting in a significant reduction in length of hospital stay (TXA: 1.6 days vs. control: 2.2 days; p = 0.0001). Conclusions: TXA is a well-tolerated drug that significantly reduces postoperative bleeding and drainage volume, resulting in earlier drain removal and reduced length of hospital stay. TXA should, therefore, be widely used in plastic surgery, especially as trends in healthcare systems necessitate more outpatient procedures and quicker postoperative recovery.

Clinical Applications of Tranexamic Acid in Plastic and Reconstructive Surgery

BACKGROUND

Tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. This study reviews the scientific evidence regarding the use of TXA in the full range of plastic and reconstructive surgery to provide clinical recommendations for safe and effective use in various plastic surgical procedures.

METHODS

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. An established appraisal process was used to rate the quality of articles (Grading of Recommendations Assessment, Development, and Evaluation methodology).

RESULTS

Forty-five studies describing the use of TXA in plastic surgery were included. There is moderate-certainty evidence to support the use of intravenous administration of TXA in craniofacial surgery procedures to reduce blood loss and transfusion requirements. There is high-certainty evidence to support the use of TXA in cosmetic surgery and intravenous administration in rhinoplasty procedures to reduce blood loss. Further high-level studies are needed to determine TXA's effects on hematoma rates in face-lift surgery and breast-related procedures. There is moderate-certainty evidence to support the use of TXA in burn care. Further studies are required to provide quantitative conclusions on the effects of TXA administration in microsurgery.

CONCLUSIONS

This is the largest study to date on the use of TXA in plastic surgery and the first to provide clinical recommendations. The literature highlights TXA's promising role in the fields of craniofacial surgery, cosmetic surgery, and burn care. Standardized, objective measurements are required to provide quantitative conclusions regarding TXA's effects on ecchymoses and edema in cosmetic surgery procedures.

The Use of Tranexamic Acid in Breast Reduction and Abdominoplasty: A Review of a Multicenter Federated Electronic Health Record Database

Background

Tranexamic acid (TXA), a fibrinolysis inhibitor, is widely used in various surgical fields to minimize blood loss. However, its efficacy and safety in plastic surgery, especially in reduction mammaplasty and abdominoplasty, remain underexplored. This study investigates the utility of intravenous (IV) TXA in these procedures, focusing on reducing postoperative complications and evaluating its safety in the context of venous thromboembolism (VTE).

Objectives

To evaluate the efficacy and safety of TXA in reduction mammaplasty and abdominoplasty.

Methods

Using data from the TriNetX LLC (Cambridge, MA) National Health Research Network database, this retrospective study compared adult patients undergoing reduction mammaplasty or abdominoplasty who received intraoperative IV TXA against those who did not. Primary outcomes included postoperative seroma and hematoma incidences, whereas secondary outcomes assessed the necessity for procedural drainage and the occurrence of VTE within 1-year postsurgery.

Results

No significant differences in the rates or risks of hematoma, seroma, or the need for procedural drainage between patients administered IV TXA and those who were not, for both reduction mammaplasty and abdominoplasty. Additionally, IV TXA did not increase the risk of VTE in either patient group.

Conclusions

IV TXA application in reduction mammaplasty and abdominoplasty does not provide added benefits in reducing postoperative complications such as seroma, hematoma, or the necessity for procedural drainage. Furthermore, it does not alter the risk of thromboembolic events. These findings highlight the need for further research, particularly through randomized control trials, to understand TXA's efficacy in plastic surgery.

Level of Evidence 3 Therapeutic

Understanding Hematoma Risk: Study of Patient and Perioperative Factors in a Large Cohort of Young Women Undergoing Reduction Mammaplasty

BACKGROUND

Despite high satisfaction rates, reduction mammaplasty can have complications such as hematoma. Factors such as age, tobacco use, and comorbidities are known contributors, whereas the influence of race, BMI, certain medications, and blood pressure (BP) remain contentious. This study investigates hematoma risk factors in young women undergoing reduction mammaplasty.

STUDY DESIGN

A retrospective review was conducted including all female patients who underwent bilateral reduction mammaplasty at a single institution between 2012 and 2022. Data on demographics, BMI, medical comorbidities, surgical techniques, medications, and perioperative BP were collected. Differences between patients who developed a hematoma and those who did not were assessed using chi-square, Fisher's exact, and t -tests. The relationship between perioperative BP and hematoma formation was assessed using logistic regression.

RESULTS

Of 1,754 consecutive patients, 3% developed postoperative hematoma of any kind, with 1.8% returning to the operating room. Age (odds ratio [OR] 1.14, p = 0.01) and ketorolac use (OR 3.93, p = 0.01) were associated with hematoma development. Controlling for baseline BP, each 10 mmHg incremental increase in peak intraoperative BP (systolic BP [SBP]: OR 1.24, p = 0.03; mean arterial pressure: OR 1.24, p = 0.01) and postoperative BP (SBP: OR 1.41, p = 0.01; mean arterial pressure: OR 1.49, p = 0.01) escalated the odds of hematoma. Postoperative SBP variability also incrementally increased hematoma odds (OR 1.48, p < 0.01). Other factors, including race and surgical technique, were not significantly influential.

CONCLUSIONS

Age, ketorolac use, and intra- and postoperative BP peaks and variability are risk factors for hematoma in reduction mammaplasty. This emphasizes the importance of perioperative BP management and optimizing pain management protocols.

Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

BACKGROUND

The established safety and efficacy of tranexamic acid (TXA) in minimizing perioperative blood loss has led to increased interest within plastic surgery. Prior studies have demonstrated decreased edema and ecchymosis and reduced rates of postoperative collection with administration of TXA; however, its use has not been reported in gender-affirming mastectomy. This represents the first study to evaluate the effects of TXA on postoperative outcomes in patients undergoing gender-affirming mastectomy.

METHODS

A single-center cohort study was performed analyzing all consecutive patients undergoing gender-affirming mastectomy with the senior author (R.B.-L.) between February of 2017 and October of 2022. Beginning in June of 2021, all patients received 1000 mg of TXA intravenously before incision and 1000 mg at the conclusion of the procedure. Patients were stratified according to intraoperative administration of TXA, with demographic characteristics, surgical characteristics, and postoperative outcomes compared between groups.

RESULTS

A total of 851 patients underwent gender-affirming mastectomy. Of these, 646 cases were performed without TXA, and 205 patients received intravenous TXA intraoperatively, as described previously. Patients who received TXA had significantly lower rates of seroma (20.5% versus 33.0%; P < 0.001) and hematoma (0.5% versus 5.7%; P = 0.002). There was no difference in rates of surgical-site infection ( P = 0.74). TXA use was not associated with increased rates of venous thromboembolism ( P = 0.42).

CONCLUSIONS

Intraoperative administration of TXA in patients undergoing gender-affirming mastectomy may safely reduce the risk of postoperative seroma and hematoma without increased risk of thromboembolic events. Additional data collection and prospective studies are warranted to corroborate these findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

BACKGROUND

Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery.

METHODS

A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output.

RESULTS

Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003).

CONCLUSIONS

This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.

Tranexamic acid in burn surgery: A systematic review and meta-analysis

Burn injury causes a coagulopathy that is poorly understood. After severe burns, significant fluid losses are managed by aggressive resuscitation that can lead to hemodilution. These injuries are managed by early excision and grafting, which can cause significant bleeding and further decrease blood cell concentration. Tranexamic acid (TXA) is an anti-fibrinolytic that has been shown to reduce surgical blood losses; however, its use in burn surgery is not well established. We performed a systematic review and meta-analysis to investigate the influence TXA may have on burn surgery outcomes. Eight papers were included, with outcomes considered in a random-effects model meta-analysis. Overall, when compared to the control group, TXA significantly reduced total volume blood loss (mean difference (MD) = -192.44; 95% confidence interval (CI) = -297.73 to - 87.14; P = 0.0003), the ratio of blood loss to burn injury total body surface area (TBSA) (MD = -7.31; 95% CI = -10.77 to -3.84; P 0.0001), blood loss per unit area treated (MD = -0.59; 95% CI = -0.97 to -0.20; P = 0.003), and the number of patients receiving a transfusion intraoperatively (risk difference (RD) = -0.16; 95% CI = -0.32 to - 0.01; P = 0.04). Additionally, there were no noticeable differences in venous thromboembolism (VTE) events (RD = 0.00; 95% CI = -0.03 to 0.03; P = 0.98) and mortality (RD = 0.00; 95% CI = -0.03 to 0.04; P = 0.86). In conclusion, TXA can potentially be a pharmacologic intervention that reduces blood losses and transfusions in burn surgery without increasing the risk of VTE events or mortality.

Safe Reproducible Breast Reduction

Breast reduction is a common operation performed by plastic surgeons. Patients can have significant improvement in physical symptoms in addition to increased self-esteem, body image, and quality of life as a result. The authors describe common techniques for breast reduction and provide representative photographs and videos of these techniques. An evidence-based review is provided for patient selection criteria, common surgical techniques, and methods to avoid and treat complications. Information is also provided on patient education about breast reduction. In most cases, breast reduction is safe to perform in the outpatient setting. The Wise pattern and vertical pattern are among the most common techniques for skin incisions, and the inferior and superomedial pedicles are two of the most common pedicles used in breast reduction. Enhanced Recovery After Surgery protocols are helpful to effectively control pain and reduce narcotic use postoperatively. Patient satisfaction after breast reduction surgery is typically high. Multiple techniques are available to successfully perform breast reduction. The plastic surgeon needs to select patients carefully and determine the appropriate technique to use. Patient education about the operation, recovery, expected result, and risks is an important component of achieving an optimal result.

Local Infiltration of Tranexamic Acid in Breast Reduction for Symptomatic Macromastia

BACKGROUND

With a surge of tranexamic acid (TXA) use in the plastic surgery community and a constant demand for breast reduction for symptomatic macromastia, questions about the benefits and risks emerge. The aims of this study are to evaluate and compare outcomes of patients undergoing breast reduction while receiving local TXA as opposed to standard procedure without TXA and to assess intraoperative bleeding and operative time.

METHODS

A retrospective review of breast reductions at a single institution from June 2020 to December 2021 was performed. The breast was infiltrated with tumescent solution at the time of surgery, with or without TXA. The population was divided into 2 groups: the TXA receiving group and tumescent only group. Demographics, intraoperative bleeding, operative time, complications, and drain duration were compared between groups. T test and χ 2 test analyses were performed on IBM SPSS.TM.

RESULTS

A total of 81 patients and 162 breasts were included. Mean age among patients was 30 ± 13.44 years. Mean SN-N distance was 32.80 ± 3.62 cm. Average resected breast specimen weight was 903.21 ± 336.50 g. Mean operating room time was 159 minutes. Intraoperative blood loss and operative time were not statistically different between groups ( P = 0.583 and P = 0.549, respectively). T-junction dehiscence was lower in the TXA group ( P = 0.016). Incidence of suture granulomas was lower in the TXA group ( P = 0.05). Drain duration was statistically significantly higher in the TXA group ( P = 0.033).

CONCLUSIONS

No decreases in intraoperative blood loss, operative time, or hematoma were seen after local administration of TXA during breast reduction. The rate of overall complications was not increased by using TXA, and incidence of T-junction dehiscence was lower in the TXA group lending to TXA's relatively safe profile. More research is necessary to further elucidate the TXA-related benefits in standard breast reductions.

The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates

BACKGROUND

Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients.

METHODS

This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications.

RESULTS

There was no significant difference in age ( P = 0.92), body mass index ( P = 0.98), percentage of smokers ( P = 0.56), operating time ( P = 0.87), estimated blood loss ( P = 0.90), or weight removed ( P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm ( P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms ( P > 0.05).

CONCLUSIONS

The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.

Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties

BACKGROUND

Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries.

METHODS

This retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson's Chi-Square and Fisher's exact tests.

RESULTS

Topical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected.

CONCLUSIONS

The incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.