Pilot Study of Combined Tranexamic Acid Therapy in Breast Reduction – Intravenous and Local Infiltration
- 1Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- 2Department of Plastic, Reconstructive and Aesthetic Surgery, São João University Hospital, Porto, Portugal
- 3RISE-Health, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Abstract
Background: Tranexamic acid (TXA) reduces perioperative blood loss in several surgical fields; however, its role in breast reduction surgery remains unclear. This study aimed to evaluate the effect of combined TXA therapy (intravenous and local infiltration) on postoperative outcomes of patients who underwent modified Liacyr Ribeiro breast reduction.
Methods: We conducted a controlled, non-randomized pilot study of patients who underwent bilateral reduction mammoplasty by the same surgeon. The intervention group received 1 g of intravenous TXA at anesthesia induction and local infiltration with a 1-mg/mL TXA vasoconstrictive solution containing epinephrine. The control group received local infiltration with an identical vasoconstrictive solution that did not contain TXA. Primary outcomes were total and daily drain output. Secondary outcomes included length of hospital stay, time to drain removal, and postoperative complications.
Results: Fifty-seven patients were included (31 in the control group and 26 in the intervention group). TXA significantly reduced the total postoperative drain volume (p<0.001) by an estimated 79% and drain output at 24h (p<0.003). In the TXA group, 53.8 % of the patients had unquantifiable drainage versus 9.7% in the control group (p=0.002). No significant differences were observed in complications, including hemorrhagic events, infections, or wound healing; indeed, the incidence of complications was low in both groups.
Conclusions: Combined TXA therapy significantly and clinically meaningfully reduced postoperative drain output. This reduction anticipates drain removal and may ultimately contribute to the broader adoption of drain-free breast reduction surgery.
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 Table of Contents or online Instructions to Authors www.springer.com/00266.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00266-026-06024-6.
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BibTeX
@article{silva2026pilot,
title = {{Pilot Study of Combined Tranexamic Acid Therapy in Breast Reduction – Intravenous and Local Infiltration}},
author = {Margarida Silva and Pedro Machado and António Sousa Barros and António Costa-Ferreira},
journal = {Aesthetic Plastic Surgery},
year = {2026},
month = aug,
doi = {10.1007/s00266-026-06024-6},
url = {https://doi.org/10.1007/s00266-026-06024-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pilot Study of Combined Tranexamic Acid Therapy in Breast Reduction – Intravenous and Local Infiltration
AU - Margarida Silva
AU - Pedro Machado
AU - António Sousa Barros
AU - António Costa-Ferreira
PY - 2026
DA - 2026/08/21
JO - Aesthetic Plastic Surgery
DO - 10.1007/s00266-026-06024-6
UR - https://doi.org/10.1007/s00266-026-06024-6
AB - Background: Tranexamic acid (TXA) reduces perioperative blood loss in several surgical fields; however, its role in breast reduction surgery remains unclear. This study aimed to evaluate the effect of combined TXA therapy (intravenous and local infiltration) on postoperative outcomes of patients who underwent modified Liacyr Ribeiro breast reduction. Methods: We conducted a controlled, non-randomized pilot study of patients who underwent bilateral reduction mammoplasty by the same surgeon. The intervention group received 1 g of intravenous TXA at anesthesia induction and local infiltration with a 1-mg/mL TXA vasoconstrictive solution containing epinephrine. The control group received local infiltration with an identical vasoconstrictive solution that did not contain TXA. Primary outcomes were total and daily drain output. Secondary outcomes included length of hospital stay, time to drain removal, and postoperative complications. Results: Fifty-seven patients were included (31 in the control group and 26 in the intervention group). TXA significantly reduced the total postoperative drain volume (p<0.001) by an estimated 79% and drain output at 24h (p<0.003). In the TXA group, 53.8 % of the patients had unquantifiable drainage versus 9.7% in the control group (p=0.002). No significant differences were observed in complications, including hemorrhagic events, infections, or wound healing; indeed, the incidence of complications was low in both groups. Conclusions: Combined TXA therapy significantly and clinically meaningfully reduced postoperative drain output. This reduction anticipates drain removal and may ultimately contribute to the broader adoption of drain-free breast reduction surgery. 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 Table of Contents or online Instructions to Authors www.springer.com/00266. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00266-026-06024-6.
SN - 0364-216X
SN - 1432-5241
ER -