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Topical Tranexamic Acid in Breast Reconstruction: A Double-Blind Randomized Controlled Trial
Tyler Safran1, Joshua Vorstenbosch1, Alex Viezel-Mathieu2
1From the Division of Plastic and Reconstructive Surgery, McGill University Health Center.
Plastic and Reconstructive Surgery
|February 24, 2023
Summary
Topical tranexamic acid (TXA) significantly reduces fluid buildup and complications after breast implant reconstruction. This method decreases drain output and lowers the overall complication rate in patients undergoing mastectomy.
Area of Science:
- Plastic Surgery
- Surgical Innovation
- Oncology
Background:
- Excess fluid accumulation (seroma/hematoma) post-breast implant reconstruction can lead to significant complications.
- Topical tranexamic acid (TXA) is being investigated for its potential to reduce fluid accumulation and subsequent complications.
Purpose of the Study:
- To investigate the efficacy of topical tranexamic acid (TXA) in reducing postoperative fluid production and complications in mastectomy pockets during immediate breast reconstruction.
Main Methods:
- A paired, double-blind, randomized controlled trial involving patients undergoing bilateral mastectomies with immediate direct-to-implant reconstruction.
- One breast pocket received 3g of TXA solution, while the contralateral pocket received normal saline.
- Solutions were soaked for 5 minutes prior to implant placement, with postoperative drain outputs and complications meticulously recorded.
Main Results:
- Topical TXA use led to a 30.5% mean reduction in drain output compared to the control side.
- Drains in the TXA-treated group were removed 1.4 days sooner on average.
- Complication rates were significantly lower in the TXA group (5.67%) versus the control group (28.3%), with a notable reduction in operative hematomas.
Conclusions:
- Soaking the mastectomy bed with topical TXA before implant insertion effectively decreases drain output and reduces postoperative complications.
- Topical TXA administration is a promising option for minimizing complications in alloplastic breast reconstruction.
