AB124. SOH25_AB_369. Does the administration of topical tranexamic acid reduce haematoma rates in breast reductions: a systematic review

Background: The risk of post op haematoma following breast reduction surgery ranges between 1% and 10%. Tranexamic is now used across surgical disciplines following excellent evidence supporting its efficacy at reducing bleeding. A survey of members of the British Association of Aesthetic Plastic Surgeons reports 83% of responders using tranexamic acid in breast reductions. However, there is unclear evidence relating to the efficacy of topical tranexamic acid use. Hence, this systematic review aims to address this.

Methods: A priori protocol was registered with PROSPERO (registration CRD42024577863). Methodology was in keeping with the PRISMA guidelines for systematic reviews. Bias was assessed via Newcastle-Ottawa Scale and the Cochrane tool for assessing risk of bias in randomised trials. All eligible articles evaluating the impact of topical tranexamic acid on haematoma rates in patients undergoing breast reduction surgery were included. Analysis was conducted via a qualitative synthesis.

Results: Overall, four studies including 789 breast reduction cases were included with 415 in the control groups and 374 receiving the intervention. There were 18 haematomas in the control group and five in the intervention group. Only one study reported statistically significant results supporting topical tranexamic acid administration. There was significant interstudy and intrastudy heterogeneity negating a meta-analysis.

Conclusions: Intravenous tranexamic acid use in breast reduction surgery is widespread. However, there is limited evidence supporting the use of topical tranexamic acid. Outcomes between studies vary and further well-designed studies are required to provide clarity on the research question.

Keywords: Tranexamic acid; breast reduction; haematoma; topical; seroma