The Role of Tranexamic Acid Use in Reduction Mammaplasty: A Systematic Review and Meta-Analysis

Reduction mammoplasty (RM) decreases breast size but may lead to complications such as hematoma. Local tranexamic acid (TXA) is applied during surgery to minimize bleeding during or after the procedure. This systematic review, conducted in August 2024 using PubMed, Ovid Medline, and Ovid Embase, assessed the impact of local TXA on RM. The Methodological Index for Nonrandomized Studies and the Revised Cochrane risk of bias (RoB2) tools were employed to assess the risk of bias. Data analysis was performed using RevMan software. In this meta-analysis of 5 studies involving 608 patients (1216 breasts) undergoing RM, 46.8% of breasts were treated with TXA. Local TXA significantly reduced the 24-h drain output (mean difference -11.49, 95% CI, -15.71, -7.26; P < .00001). Higher TXA concentrations (20 and 25 mg/mL) significantly reduced hematoma rates (odds ratio [OR] 0.09, 95% CI, 0.03, 0.30; P < .0001), whereas lower concentrations showed no similar effect. TXA also reduced the complication rates in RM (OR 0.63, 95% CI, 0.50, 0.80; P = .0002), although its impact on drain utilization, duration, and seroma rates was not statistically significant. Local TXA showed promising results, because it reduced the 24 h drain output, overall occurrence of postoperative complications, and when used in higher concentrations, decreased the hematoma formation. However, we need further randomized controlled trials to confirm the efficacy of different concentrations of TXA in RM. Level of Evidence: 3 (Therapeutic).