Efficacy of topical tranexamic acid in gender-affirming mastectomy

Bleeding complications, such as hematoma, are frequently encountered after breast surgery. To mitigate these complications, the use of tranexamic acid (TXA), has become increasingly popular in breast procedures. This study aims to investigate the impact of topical moistening of the surgical wound with TXA on the reduction of postoperative bleeding complications in patients undergoing gender-affirming mastectomy (GAM).

A single-center retrospective cohort study examined postoperative bleeding outcomes in patients who underwent GAM between April 2014 and March 2024. The use of intraoperative topical TXA was documented, along with rates of hematoma, seroma, and other postoperative complications.

The study included 456 patients: 62 who received topical moistening with 10 mL of 50 mg/mL TXA on each breast and 394 control patients who received standard hospital protocol for intraoperative hemostasis. Postoperative hematoma occurred in 3 patients (4.9%) who received topical TXA and 18 patients (4.6%) who did not (p=0.92). The incidence of other postoperative complications did not significantly differ between the groups.

This study found no statistically significant differences in postoperative bleeding complication rates between patients who received TXA and those who followed the standard hemostasis protocol. Although our results suggest that topical TXA is safe and does not increase thromboembolic risk, its efficacy in reducing bleeding complications in GAM patients remains uncertain. The study's limitations, including its single-center design and small sample size, highlight the need for larger, multicenter randomized trials to establish the role of topical TXA in improving postoperative outcomes for GAM procedures.