Tranexamic Acid in Breast Surgery: A Decade of Prospective Evidence

PURPOSE:
While tranexamic acid (TXA) has become increasingly utilized in aesthetic and reconstructive breast procedures, definitive evidence from long-term prospective studies remains fragmented. This meta-analysis synthesizes ten years of prospective clinical data to provide a consolidated assessment of TXA’s efficacy and safety profile in breast surgery.

METHODS:
A systematic review of prospective cohort studies from 2015 to 2025 evaluated the perioperative use of intravenous or topical TXA in breast surgery. Primary endpoints included rates of hematoma and seroma formation, while secondary outcomes included drain output and overall complication rates.

RESULTS:
Seventeen studies encompassing 2,543 patients met inclusion criteria, with a mean follow-up of 21.3 ± 11 months. TXA administration was associated with a 62% reduction in hematoma risk (OR 0.37; 95% CI 0.24–0.74; p < 0.001) and a 32% reduction in seroma formation (OR 0.68; 95% CI 0.25–0.82; p = 0.009). No significant differences were observed in postoperative drain output (p = 0.42). Heterogeneity was low (I² = 24%), and no publication bias was detected (p = 0.31). No TXA-related adverse events were reported.

CONCLUSION:
This decade-spanning meta-analysis of prospective studies provides robust evidence that TXA significantly reduces hematoma and seroma rates in breast surgery without compromising safety. These findings support TXA as a safe, effective adjunct in perioperative protocols and underscore its role in modern hematoma prevention strategies across aesthetic and reconstructive breast procedures.