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

Abstract

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.

A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery

“…However, there are no standardised recommendations for TXA in aesthetic surgery. Similar to our studies, Parmeshwar et al (Parmeshwar et al 2023 ) showed a significant reduction in haematoma formation seen in patients who received TXA in any form.…”

“…Postoperative haematomas are one of the most significant bleeding complications of plastic surgery, as they may require a return to the hospital or operating room for drainage or evacuation (Gelidan et al 2023 ). TXA has been shown to reduce haematoma formation during breast surgery (Parmeshwar et al 2023 ; Weissler et al 2020 ; Rifkin et al 2023 ). Prevention of haematoma listed in the literature includes strict blood pressure control, early discontinuation of nonsteroidal anti-inflammatory drugs and aspirin, intraoperative hemostatic agents, postoperative pain and nausea management, and monitoring of dressing and drains (Bloom et al 2021 ; Chen et al 2023 ; Cason et al 2021 ; Stewart et al 2024 ).…”

“…TXA is effective when administered systematically and topical. However, the ideal method of administration has not been established (Parmeshwar et al 2023 ; Xu et al 2021 ). Its oral bioavailability is 30 to 50%, and its renal elimination is more significant than 95%.…”

Contemporary Prophylactic Antibiotic Practices and Adjunct Therapies in Autologous Fat Grafting Procedures: A Survey of The Aesthetic Society Members

“… 23-25 TXA has also shown promise in minimizing blood loss and hematoma formation in breast plastic surgery, with benefits from both topical and intravenous applications. 26 Additionally, a retrospective review involving 60 patients showed reduced bruising at donor sites with locally infiltrated TXA. 27 Our group's systematic review further supports TXA's blood-saving effects during liposuction and fat grafting.…”