Pilot Study of Combined Therapy with Tranexamic Acid in Breast Reduction

Abstract

Background: Tranexamic acid (TXA) reduces perioperative blood loss in several surgical fields, but its role in breast reduction surgery remains unclear. Recently, conflicting results have been published. Objectives: Evaluate the effect of combined TXA therapy (intravenous and local infiltration) on several outcomes and complications in patients submitted to a modified Liacyr Ribeiro breast reduction. Methods: We conducted a prospective, controlled, non-randomized study on patients who underwent bilateral reduction mammoplasty by the same surgeon. The intervention group received 1 g of intravenous TXA at anesthetic induction and local infiltration with a vasoconstrictive solution with 3% TXA, whereas the control group received local infiltration with an identical vasoconstrictive solution without TXA. Patient characteristics were analyzed. The primary outcomes were total and daily postoperative drain output, while secondary outcomes assessed the length of hospital stay, time to drain removal, complications (local and systemic), unscheduled care, re-admission and re-operation rates. Results: Fifty-seven patients underwent reduction mammaplasty, with 31 in the control group and 26 receiving TXA. Baseline characteristics were similar between groups. TXA significantly reduced total postoperative drain volume(p<0.001) and drain output at 24h(p<0.003). There were no significant differences observed in complications, including hemorrhagic events, infections, or wound healing. Notably, the incidence of complications was quite low in both groups. Conclusions: The combined TXA therapy with intravenous and local infiltration leads to a statistically significant and clinically meaningful reduction in postoperative drain output. This reduction facilitates earlier drain removal and may ultimately contribute to the broader adoption of drain-free breast reduction surgery.