S. Mehta1, N. Parmeshwar1, M. Piper1 1University Of California – San Francisco, Plastic And Reconstructive Surgery, San Francisco, CA, USA
Introduction:
Topical and intravenous use of the antifibrinolytic tranexamic acid (TXA) has been shown to reduce intraoperative bleeding and post-operative ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. Hematoma and subsequent reoperation rate in breast surgery have been cited from 2-5%, thus hemostatic agents are often required intraoperatively. The purpose of this systematic review is to evaluate the impact of TXA on hematoma and seroma incidence in breast surgery.
Methods:
A thorough literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted. All studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy were included. Outcomes of interest included rate of hematoma and seroma formation.
Results:
Twelve studies met inclusion criteria with a total of 3,135 breasts, of which 1,574 were treated with any TXA, 663 with only topical TXA, and 1,561 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared to control (OR 0.36, p<0.001), and a similar tendency toward lower hematoma with topically treated TXA compared to control (OR 0.37, p=0.06). There was no statistically significant difference in seroma formation with any TXA (OR 0.85, p=0.37) or topical TXA (OR 0.94, p=0.8).
When stratified by type of surgery, there was a statistically significant decrease in hematoma formation with use of any TXA compared to the control group for oncologic mastectomy (OR=0.25, p=0.003), and any reduction mammoplasty (OR 0.43, p=0.004). Additionally, when stratified by type of surgery, there were no significant differences in seroma formation with any TXA, or with topical TXA in either cohort.
Conclusion:
This review suggests that any use of TXA may significantly reduce hematoma formation in breast surgery and trends toward decreased seroma formation. Future prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and ecchymosis in breast reconstruction patients.