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Bleeding, Drains, And Returns To Or In Transmasculine Chest Surgery: What 5,068 Mastectomies Tell Us About Tranexamic Acid
Yousef Tanas, MD1, Nina Pollack, MD
1, Philong Nguyen, BS
2, Joshua Wang, MS
2, Pablo Padilla, MD
1.
1Houston Methodist Hospital, Houston, TX, USA,
2University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: Hematoma, seroma, and unplanned re-operation are the most frequent early complications after gender-affirming mastectomy with hematoma being the most common complication and the most common reason for reoperation. Tranexamic acid (TXA) is increasingly incorporated into enhanced-recovery protocols, yet its route-specific benefits remain unclear.
METHODS: In accordance with PRISMA guidelines, PubMed, Scopus, and Web of Science were searched in June 2025 for comparative studies of TXA vs no TXA in trans-masculine chest surgery. Review Manager 5.4 was used for statistical analysis.
RESULTS: Seven studies (5,068 breasts) met inclusion criteria. Overall TXA significantly reduced hematoma risk by 41% (RRR = 41%; RR = 0.59, 95% CI: 0.41-0.83; P = 0.003; IČ = 3%). Subgroup analysis demonstrated that the benefit was confined to IV TXA (RR 0.49, 0.25-0.95), not topical (RR 0.74, 0.43-1.26). Unplanned returns to OR fell by 62 % with IV TXA (RRR = 62%; RR = 0.38, 0.23-0.64. Overall effect on seroma was non-significant (RR 0.89, 0.59-1.36), but subgroup analysis showed that IV TXA lowered seroma risk by 33 % (RRR = 33%; RR 0.67, 0.51-0.88; P = 0.004); topical showed no benefit. TXA did not increase thrombo-embolism.
CONCLUSION: IV TXA safely reduces risks of hematoma, seroma, and re-operation after gender-affirming mastectomy, without increasing VTE risk. Topical TXA confers no measurable advantage.
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