Tranexamic Acid and the Risk of Hematoma and Seroma Following Implant-Based Breast Reconstruction: A Retrospective Study of 1782 Patients

BACKGROUND: Intraoperative tranexamic acid (TXA) is used increasingly during implant-based breast reconstruction to reduce hematoma and seroma formation. However, evidence supporting the effectiveness of TXA in this setting remains limited.

OBJECTIVES: The authors of this study aim to compare the risk of hematoma and seroma in patients treated with and without intraoperative intravenous TXA during implant-based breast reconstruction.

METHODS: Medical records of patients who underwent breast reconstruction at 3 plastic surgical departments between 2010 and 2023 were retrospectively reviewed. We compared the risk of hematoma and seroma between patients treated with and without intraoperative intravenous TXA using robust multivariable Cox regression with inverse probability of treatment weighting.

RESULTS: We included 1782 patients who underwent implant-based breast reconstruction, of whom 352 received intraoperative intravenous TXA. A multivariable analysis showed a nonsignificant reduction in the risk of hematoma (hazard ratio [HR] 0.81; P = .51) and seroma (HR 0.88; P = .68) in patients who received TXA. Furthermore, the time to hematoma was significantly longer (2 vs 1 day, P = .03), as well as the time to drain removal (7 vs 6 days, P < .001) for patients treated with TXA. However, the time to discharge was significantly shorter (4 vs 5 days, P < .001).

CONCLUSIONS: Intraoperative administration of TXA was associated with a nonsignificant reduction in the risk of hematoma and seroma, suggesting a limited clinical effect in patients undergoing implant-based breast reconstruction. However, future studies are needed to definitively determine the effects in implant-based breast reconstruction.