Impact of systemic tranexamic acid on postoperative drainage in large-volume reduction mammaplasty

Optimizing clinical outcomes and postoperative recovery plays a key role in surgical procedures. We evaluated the effects of systemic tranexamic acid (TXA) administration on postoperative drainage in patients undergoing large-volume reduction mammaplasty.

A retrospective cohort analysis was performed by including 104 patients (208 breasts) who underwent large-volume reduction mammaplasty, defined as resection weights ≥ 500 g per breast. Overall, 59 patients (118 breasts) received intraoperative intravenous TXA, whereas 45 patients (90 breasts) served as a historic control cohort treated prior to routine TXA implementation. Postoperative drainage-related outcomes were assessed using time-dependent drain output (24 and 48 h), total drainage volume, and drainage duration. Furthermore, length of hospital stay, hemoglobin decline on the first postoperative day, bleeding-related complications, and thromboembolic events were evaluated as secondary outcomes.

Systemic TXA administration was associated with lower postoperative drain output within the first 24 h, with statistically significant differences at 48 h (54 mL versus 80 mL, 32.5%) and in total drainage volume (68 mL versus 117 mL, 41.9%) per breast. Patients receiving TXA demonstrated a significantly shorter drainage duration and hospital stay (p < 0.0001). Absolute and relative hemoglobin decline did not differ between the groups. Bleeding-related complications were observed less frequently in the TXA group (1.7% versus 13.3%) and no thromboembolic events were observed in either group during the study period, although the number of events was low.

Systemic administration of TXA in large-volume reduction mammaplasty is associated with reduced postoperative drainage, accompanied by shorter drain duration and length of hospital stay.