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Intravenous Tranexamic Acid Safely Reduces Hematoma Without Thromboembolic Events In Implant-Based Breast Reconstruction
Jason M. Weissler, Joseph Banuelos, M.D., Steven Jacobson, M.D., Oscar J. Manrique, M.D., Minh-Doan T. Nguyen, M.D., Christin A. Harless, M.D., Nho V. Tran, M.D., Jorys Martinez-Jorge, M.D..
Mayo Clinic, Rochester, MN, USA.

PURPOSE: Antifibrinolytic medications, such as tranexamic acid (TXA) have recently garnered increased attention in plastic surgery. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research on TXA in breast reconstruction. The aim of this study was to investigate whether intravenous TXA reduces the risk of postoperative hematoma following immediate implant-based breast reconstruction.
METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate implant-based breast reconstruction following mastectomy over two years (2015-2016). The authors reviewed the incidence of postoperative hematomas amongst all patients who either did, or who did not receive intravenous TXA at the time of surgery. The patients in the intervention group received 1000 mg of intravenous TXA prior to incision and 1000 mg at the conclusion of the procedure. Demographic and surgical characteristics were collected for all patients. The primary outcome measure was hematoma. Additionally, adverse events, such as thromboembolic occurrences were captured. Logistic regression analysis was performed using Fisher’s exact test and the Mann-Whitney-Wilcoxon test. Results with a p value of <0.05 were considered significant.
RESULTS: A total of 499 patients were included in this study. Overall, 116 patients (217 breasts) received intravenous TXA, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar amongst the two groups. After controlling for age, hypertension, type of reconstruction (pre-pectoral or sub-pectoral), and mastectomy type (nipple-sparing or skin-sparing), patients who received intravenous TXA were less likely to develop hematomas (n=1; 0.46%) than patients who did not receive TXA (n=19; 2.9%) [p=0.018]. Adverse effects of intravenous TXA, including thromboembolic phenomena were not observed.
CONCLUSION: The use of tranexamic acid in immediate implant-based breast reconstruction is associated with a decreased risk of hematoma, with an acceptable safety profile. Further prospective randomized studies are warranted to further corroborate these findings.


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