The Impact of Tranexamic Acid Administration Route on Outcomes in Reduction Mammaplasty.

Abstract

Background: Postoperative hematoma requiring unplanned intervention remains a clinically significant complication following reduction mammaplasty. Tranexamic acid (TXA) is increasingly used to reduce its occurrence and perioperative bleeding, but the optimal route of administration in breast reduction surgery remains unclear.

Objectives: This study aimed to evaluate the effects of different TXA administration routes on hematoma incidence and perioperative outcomes in patients undergoing reduction mammaplasty.

Methods: We conducted a retrospective cohort study of consecutive patients who underwent bilateral reduction mammaplasty at a single institution between 2020 and 2024. Patients were stratified into three groups according to the route of TXA administration: intravenous, topical, or combined intravenous plus topical. Group differences were evaluated using univariate analyses and multivariable logistic regression.

Results: A total of 272 patients were included. The incidence of postoperative hematoma requiring intervention was low (0.0-2.4%) and did not differ significantly between groups. Estimated intraoperative blood loss was significantly higher in the intravenous TXA group (p  =  0.004). Partial or total nipple-areolar complex necrosis occurred more frequently in the combined TXA group (7.7%; p  =  0.056 overall, with pairwise p  =  0.013 compared to other groups). In multivariable analysis, comorbidity burden showed a trend toward predicting postoperative hematoma.

Conclusions: The route of TXA administration did not significantly affect hematoma rates. Although a higher incidence of nipple-areolar complex necrosis was observed in the combined TXA group, this finding is based on a small number of events and should be interpreted with caution. Prospective studies are needed to further evaluate the optimal TXA administration strategy in reduction mammaplasty.

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