Utility of Tranexamic Acid in Reduction Mammaplasty: A Systematic Review and Meta-Analysis.

Background: The use of tranexamic acid (TXA) in reduction mammaplasty is increasing among plastic surgeons. Its efficacy and impact on complications, however, are not yet well understood. This study aims to comprehensively evaluate the impact of TXA on postoperative outcomes in reduction mammoplasty.

Methods: A systematic review was conducted according to PRISMA guidelines. Five databases were queried to identify studies reporting TXA application in breast surgery. A dual-screener approach was employed to select reduction mammaplasty studies for full-text screening. Primary outcomes assessed were hematoma and seroma; secondary outcomes assessed were surgical site infection (SSI), nipple-areola complex (NAC) necrosis, drain output, drain duration, and thromboembolic events. Data were pooled, and a meta-analysis was performed. Odds ratios (OR) and mean differences were reported via the Mantel-Haenszel and Inverse-Variance methods, respectively.

Results: Seven studies with a total of 1396 patients were included, with 53.1% of patients (n = 741) receiving TXA. Of those receiving TXA, 100% of patients received TXA intraoperatively, and 62.6% of patients (n = 464) received both topical and intravenous administration. TXA administration significantly reduced postoperative hematoma formation (OR 0.35; 95% CI [0.20-0.63]; P < 0.001), with 2.3% of patients (n = 17) developing hematomas in the TXA group, compared to 7.2% of patients (n = 47) in those who did not receive TXA. No statistically significant differences were found in seroma rates, SSI, NAC necrosis, or drain duration. No thromboembolic events were reported in either group.

Conclusion: TXA administration during reduction mammaplasty reduced the incidence of postoperative hematoma formation without increasing complications.

Level of evidence iii: 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 .