Impact of intravenous tranexamic acid administration on reduction mammoplasty outcomes

Background The growing use of tranexamic acid (TXA) in plastic surgery warrants an accurate analysis of efficacy for body contouring indications. We offer the largest cohort evaluation of intravenous TXA use in minimizing postoperative complications following reduction mammoplasty. Methods A single-institution retrospective analysis was conducted on consecutive reduction mammoplasty procedures performed between February 2023–August 2024. Patient demographics, intraoperative factors, and postoperative complications were collected and summarized using descriptive statistics. Groups were stratified based on administration of TXA, with differences assessed using Pearson's chi-square test for categorical variables and Student's t -test or Wilcoxon rank sum test for continuous variables, as appropriate. Association of perioperative intravenous TXA use with postoperative complications was analyzed by breast with multivariable logistic regression. Results Of 406 patients (812 breasts), 213 patients (426 breasts) were administered TXA perioperatively. Neither group had significant differences in Caprini score, prior history of DVT, or anemia. Multivariable regression analysis, controlling for differences in demographics and operative characteristics, demonstrated that TXA use was significantly associated with decreased rates of dehiscence (aOR = 0.50, 95% CI 0.28–0.91, p = 0.023) and scar revision (aOR = 0.30, 95% CI 0.12–0.76, p = 0.015). Among breasts that were only closed with barbed sutures, after adjustment for demographics and operative characteristics, TXA use was significantly associated with lower rates of scar revision only (aOR = 0.16; 95% CI 0.05–0.52; p = 0.005). Conclusion Intravenous TXA use in reduction mammoplasty confers lower rates of postoperative wound complications, though its impact may be secondary to wound closure technique.