BACKGROUND: Tranexamic acid (TXA) has been demonstrated to be a valuable pharmacologic adjunct capable of decreasing intraoperative blood loss, hematoma, seroma, and bruising amongst various plastic surgery procedures. Despite its proven efficacy, safety, and acceptable cost profile in both the intravenous and topical form, the use of TXA in breast reconstruction remains understudied. As such, the purpose of this study is to investigate whether the topical administration of TXA reduces the risk of postoperative seroma and time until drain removal following immediate implant-based breast reconstruction (IBR).
METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate first stage IBR following mastectomy between 2018 and 2020. Demographics, comorbidities, radiation history, and surgical characteristics were collected for all patients. The authors reviewed the incidence of postoperative seromas, days until drain removal, and hematomas amongst all patients who either did or did not receive topical TXA at the time of surgery. A minimum of 1 month of follow-up was required for inclusion. The patients in the intervention group received 75 ml of TXA (3 g in NaCl 0.9%), which was applied topically into the breast pocket before closure. Postoperatively, all drains were maintained to bulb suction and outputs were recorded. Drains were removed upon meeting removal criteria (<30 ml for 2 consecutive 24-hour periods). Adverse events, such as thromboembolic occurrences, were captured. Univariate analyses of demographic variables and postoperative outcomes were performed using Fisher’s exact test for categorical variables and Mann–Whitney–Wilcoxon test for continuous variables.
RESULTS: A total of 364 patients were included in this study. Overall, 208 patients (374 breasts) received topical TXA, whereas 156 patients (280 breasts) did not. Patient characteristics and comorbidities were similar among the groups. The location of tissue expander placement (prepectoral versus subpectoral), mastectomy specimen weight, and use of acellular dermal matrix were also similar among the cohorts. Patients who received TXA were more likely to undergo nipple-sparing mastectomy (n = 232, 62%) than the patients who did not receive TXA (n = 125, 44.6%) (P < 0.0001). Patients who received topical TXA were significantly less likely to develop postoperative seromas (n = 28, 7.5%) than patients who did not receive TXA (n = 35, 12.5%) (P = 0.032). Furthermore, patients who received TXA also had their surgical drains removed significantly earlier (12.3 ± 4.3 days) than the patients who had not received topical TXA (13.1± 4.9 days) (P = 0.024). Rate of hematoma among patients who received TXA (n = 3, 0.8%) was not significantly different than the patients who did not (n = 5, 1.8%) (P = 0.256). Adverse effects of TXA were not observed. Average follow-up among the TXA group and patients who did not receive TXA was 6.1± 3.9 months and 5.9± 2.8 months, respectively (P = 0.675).
CONCLUSION: In the first reported use of topical TXA during IBR, the authors conclude that the use of topical tranexamic acid is associated with both a decreased risk of postoperative seroma and decreased drain duration, with an acceptable safety profile. Larger cohort analyses and prospective randomized controlled studies are warranted to further support these findings.