BACKGROUND: Research across surgical subspecialties has demonstrated inconsistent results regarding the effectiveness of the antifibrinolytic agent tranexamic acid (TXA) in reducing hematoma and seroma rates, with few studies focusing on gender-affirming mastectomies. With no consensus on routine usage, this study evaluates gender-affirming mastectomies with and without TXA and reviews postoperative complications. METHODS: A retrospective cohort study, using the TrinetX 20-year database of 133 million U.S. medical records, identified patients undergoing gender-affirming mastectomies. Patients were separated according to the intraoperative use of TXA. Demographics and postoperative outcomes were evaluated including seromas, hematomas, infections, and thromboembolisms. RESULTS: There were 951 gender-affirming mastectomies performed with TXA and 7,929 without. After propensity-score matching, 951 patients remained in each cohort. The mean age was 26.6, and mean body mass index was 29.1. The TXA cohort had a lower rate of hematoma (1.8% versus 2.3%, respectively; p=0.4) and seroma (0.8% versus 1.4%, respectively; p=0.1) but with no significant difference. TXA use was not associated with an increased risk of thromboembolisms (p=0.9) or infections (p=0.6). The TXA cohort had a significantly lower incidence of emergency room visits within three months post-mastectomy (4.0% versus 6.0%, respectively; p=0.046). CONCLUSION: Gender-affirming mastectomies are safe and effective treatment options. TXA usage was not associated with an increased risk of hematomas, seromas, or thromboembolisms, but had a lower incidence of emergency room visits post-mastectomy, which may be due to the lower rate of overall postoperative complications. Surgeons may consider prescribing TXA in gender-affirming mastectomies in specific individuals based on clinical judgment.
Cordero et al. (Fri,) studied this question.
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