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

Abstract

Background: Previous studies demonstrated the effectiveness and safety of tranexamic acid (TXA) in several surgical specialities. Recent publications suggested that TXA may also be beneficial in plastic surgery, including breast procedures. Objectives: 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 carried out according to PRISMA 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 tools. Results: Our systematic review included seven studies: three randomized controlled trials and four retrospective cohorts, involving 1234 female patients (2232 breasts), 741 of whom received TXA (60%). Four studies used topical TXA, two used intravenous TXA, one used locally infiltrated TXA, and another study combined locally infiltrated TXA with intravenous TXA. Four studies demonstrated benefits from TXA administration, while three studies did not. Topical TXA used just before wound closure resulted in a 42% reduction in drain fluid output and in a ten times reduction in major hematoma. The administration of intravenous TXA during induction resulted in a significant reduction in postoperative major and minor hematoma. The combined use of intravenous 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.