PURPOSE: Antifibrinolytic medications, such as tranexamic acid (TXA), have recently garnered increased attention in plastic surgery. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research on TXA in breast reconstruction. The aim of this study was to investigate whether intravenous TXA reduces the risk of postoperative hematoma following immediate implant-based breast reconstruction.
METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate 2-stage IBR following mastectomy over 2 years (2015–2016). The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1,000 mg of intravenous TXA before mastectomy incision and 1,000 mg at the conclusion of the procedure. Fisher’s exact test and the Mann-Whitney–Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous TXA after adjusting for possible confounders.
RESULTS: A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous TXA, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar among the groups. Patients who received TXA were less likely to develop hematomas (n = 1; 0.46%) than patients who did not (n = 19; 2.9%) after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral; P = 0.018). Adverse effects of intravenous TXA, including thromboembolic phenomena, were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma.
CONCLUSION: Intravenous TXA safely reduces risk of hematoma in IBR. Further prospective randomized studies are warranted to further corroborate these findings.