Is Topical Tranexamic Acid Effective in Reducing Hematoma and Seroma in Breast Surgery? A Systematic Review and Meta-analysis.

[BACKGROUND] Postoperative fluid-related complications, such as hematoma and seroma formation, are common concerns in breast surgery, adversely affecting surgical outcomes and patient recovery. Topical tranexamic acid (TXA) has emerged as a promising intervention to minimize bleeding while reducing systemic adverse effects linked to intravenous administration. However, evidence on the efficacy of topical TXA in breast surgery remains sparse.

[METHODS] This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language databases were searched through April 2024 to identify randomized controlled trials and cohort studies assessing the effects of topical TXA on postoperative outcomes in breast surgery, including hematoma, seroma, infection rates, and drain output/duration.

[RESULTS] Six studies, encompassing 823 patients and 1477 breasts, were included. Subgroup meta-analysis demonstrated a statistically significant reduction in hematoma rates in patients who underwent mastectomy (risk ratio [RR] = 0.14; 95% confidence interval [CI], 0.03-0.78; = 0.02), but not in patients who underwent breast reduction (RR = 0.76; 95% CI, 0.08-7.08; = 0.24). No significant differences were found in overall hematoma rates (RR = 0.32; 95% CI, 0.08-1.195; = 0.09), seroma formation (RR = 1.22; 95% CI, 0.99-1.51; = 0.07), or infection rates (RR = 0.85; 95% CI, 0.46-1.56; = 0.59).

[CONCLUSIONS] Topical TXA significantly reduced hematoma rates in patients who underwent mastectomy but showed no significant effect on other outcomes. Larger studies with standardized methodologies are required to fully establish the role of topical TXA in optimizing breast surgery outcomes.