Related Experiment Video
Updated: May 20, 2026
Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
Published on: August 19, 2025
Procedure-Specific Efficacy of Tranexamic Acid in Breast Surgery: A Propensity-Score Adjusted Analysis of 5,202
Or Friedman1,2, David Maiershon1, Yuval Paniri3
1The Dina Recanati School of Medicine, Reichman University, POB 167, 8 Ha'universita Street, Herzliya 4610101, Israel.
Background:
Hematoma remains a major complication following breast surgery. While tranexamic acid (TXA) efficacy is established in reduction mammaplasty, its utility across other breast procedures remains unclear.
Methods:
This retrospective cohort study included 5,202 consecutive procedures (2019-2025) performed by multiple surgeons at a single private hospital: primary augmentation (n=3,738), reduction mammaplasty (n=943), explantation with mastopexy (n=358), and explantation alone (n=163). TXA administration was at surgeon discretion. Inverse Probability of Treatment Weighting controlled for temporal adoption bias and confounders. Primary outcome was hematoma requiring surgical intervention within 30 days; isolated ecchymosis without palpable collection was not classified as hematoma.
Results:
TXA adoption increased from 7.0% (2019) to 93.0% (2025). After achieving covariate balance (all SMD <0.2), procedure-specific effects emerged. In reduction mammaplasty, TXA significantly reduced hematoma (2.2% vs 7.2%; adjusted OR 0.28, 95% CI 0.14-0.58, p<0.001; NNT=20). Explantation with mastopexy showed similar benefit (1.6% vs 6.0%; OR 0.42, 95% CI 0.20-0.88, p<0.001). Primary augmentation demonstrated no statistically detectable difference (1.2% vs 1.2%; OR 0.94, 95% CI 0.36-2.42, p=0.905), regardless of implant plane. No thromboembolic events occurred. Surgical site infection showed a nominally significant difference (OR 0.47, p=0.02) but should be considered exploratory given small event counts and absence of a plausible biological mechanism. Seroma and wound dehiscence showed no significant differences.
Conclusions:
TXA efficacy is procedure-dependent. It provides significant protection in reduction mammaplasty and mastopexy involving extensive parenchymal dissection, but shows no statistically detectable benefit in primary augmentation. These findings support procedure-specific practice guidance rather than universal prophylaxis.
