Tranexamic acid and breast reduction

Can topical tranexamic acid reduce postoperative bruising in breast reduction?

A recent study published in Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery this July . by Amy Yao, MD, and her team addresses an important question in plastic surgery: the effectiveness of topical tranexamic acid (TXA) in reducing postoperative hematomas in reduction mammoplasty.

Study Context

Reduction mammoplasty is one of the most common procedures in plastic surgery, but it carries a significant risk of postoperative hematoma, with a reported incidence between 1% and 7%. It is known that TXA can reduce perioperative bleeding and the need for transfusions when administered intravenously or topically in various surgeries. However, its use in plastic surgery has been limited.

Study Design

The team conducted a randomized, double-blind clinical trial with 98 patients (196 breasts) undergoing bilateral reduction mammoplasty. In each patient, one breast was treated with 1000 mg of topical TXA prior to closure, while the other received saline as a placebo. Neither the surgical team nor the patients knew which breast had received TXA. The researchers compared postoperative complications, including the incidence of hematoma within 30 days after surgery, drain volume, and duration of drain use between TXA-treated and placebo-treated breasts.


The study found that the overall hematoma rate was 1.5%, and there was no significant association between the application of TXA and the development of hematomas (P = 0.56) or other complications. The rate of hematoma in the study patients was similar to the overall rate during the study period (1.5% vs. 2.4%; P = 0.511). In a multivariate model, TXA was not significantly associated with differences in drain volume after controlling for resection weight, age, and duration of drain use (P = 0.799). In addition, no adverse effects or thromboembolic events related to TXA were observed.


Topical application of tranexamic acid does not reduce the incidence of hematoma after reduction mammoplasty. This finding is crucial for plastic surgeons seeking effective methods to minimize postoperative complications. Although TXA has demonstrated benefits in other surgical areas, its topical use in reduction mammoplasty does not appear to provide a significant advantage in hematoma prevention.

This study underscores the importance of continuing to research and critically evaluate potential interventions in plastic surgery to ensure that patients receive the most effective and safest treatments available.


Ref: DOI: 10.1097/PRS.0000000000010952