Efficiency of Tranexamic Acid for Prevention of Bleeding In Breast Surgery: A Systematic Review

Why clinicians should know about it

• Picked for Breast and Endocrine Surgery (paper of the day, 30 September 2026): Systematic review, TXA reduces hematoma/seroma in breast surgery

Abstract

BACKGROUND: Hematoma and seroma formation are common postoperative complications following breast surgery that adversely affect both surgical outcomes and patient recovery. Tranexamic acid (TXA) is increasingly recognized as an effective prophylactic agent; however, evidence regarding its efficacy in breast surgery remains limited. METHODS: This systematic review aimed to evaluate the effect of perioperative TXA administration on postoperative outcomes in breast surgery. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. English-language databases were searched through March 2025 for randomized controlled trials and cohort studies evaluating the effect of TXA on postoperative outcomes in breast surgery, including hematoma formation, seroma formation, drain output and duration, and other adverse events. RESULTS: Thirteen studies encompassing 3,496 patients were included. TXA demonstrated consistent benefits in mastectomy and breast reconstruction, significantly reducing drain output, seroma rates, and hematoma incidence. Drain output was reduced by 30-33% in several studies, with earlier drain removal reported. Results in reduction mammaplasty were inconsistent, with some studies reporting reduced hematoma and drainage and others showing no significant differences. CONCLUSIONS: TXA shows promise for reducing postoperative complications in breast surgery, particularly in mastectomy and reconstruction. Given its favorable safety profile, TXA should be considered as part of a comprehensive perioperative strategy. Further research is needed to establish optimal dosing protocols, especially for reduction mammaplasty. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as published, via PubMed.