Effect of Tranexamic Acid to Reduce Postoperative Hematoma in Reduction Mammaplasty: A Retrospective Analysis of 656 Patients

Abstract Background Postoperative hematoma requiring reoperation is a clinically significant complication in breast surgery. Although tranexamic acid (TXA) is widely used in other surgical specialties to reduce bleeding, its routine use in breast surgery remains limited due to insufficient evidence. Aims and Objectives This study aimed to evaluate whether intraoperative TXA reduces the incidence of hematoma following reduction mammaplasty. Materials and Methods We conducted a retrospective, single-center cohort study including 656 consecutive patients who underwent reduction mammaplasty between 2019 and 2024. TXA was administered intravenously (n = 124, 43%), topically (n = 124, 43%), or via both routes (n = 39, 14%) according to surgeon preference. Patients exposed to TXA were compared with those unexposed. Results TXA use was associated with a significantly lower rate of postoperative hematomas requiring reoperation (2.1% vs. 5.1%; OR 2.3, 95% CI: 1.1–5.0; p = 0.042). Operative time was longer in the TXA group (133 vs. 122 minutes; p < 0.001), and patients receiving TXA had higher intraoperative blood loss and breast resection weights. No significant differences were observed in overall complications or 30-day reoperation rates, although superficial infections were more frequent in the non-TXA group (3.8% vs. 0.7%; p = 0.022). Multivariable analysis suggested a trend toward TXA as an independent protective factor. No TXA-related adverse events were reported. Conclusions Intraoperative TXA in reduction mammaplasty was associated with a more than twofold reduction in postoperative hematomas. As a simple and low-risk intervention, TXA may reduce the need for reoperation. Large randomized controlled trials are warranted to confirm these findings and guide definitive clinical recommendations. 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 .