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. 2025 Jan 10:43:458-469.
doi: 10.1016/j.jpra.2025.01.002. eCollection 2025 Mar.

Topical Tranexamic Acid and Chest Masculinization Surgeries-Impact on Postoperative Hematoma Incidence

Krisztina Sipos  1 , Katriina Joensuu  2 , Susanna Kauhanen  1 , Kaisu Ojala  1
Affiliations

Topical Tranexamic Acid and Chest Masculinization Surgeries-Impact on Postoperative Hematoma Incidence

Krisztina Sipos et al. JPRAS Open. .

Abstract

Introduction: Postoperative hematoma requiring intervention occurs more frequently in chest masculinization surgeries than in other types of breast surgeries, with incidences ranging from 0.7% to 13.2% per patient. Although there is increasing evidence that topically applied tranexamic acid (TXA) effectively reduces postoperative bleeding in breast surgeries, its impact on masculinization surgeries is understudied.

Aims: Examining the significance of topical TXA in reducing postoperative hematoma in chest masculinization surgeries.

Methods: This retrospective cohort comprises female-to-male transgender and non-binary patients who underwent chest masculinization at Helsinki or Tampere University hospitals between 2018 and 2024. Topical TXA (20 mg/ml, 25 ml per breast) was incorporated into routine use in October 2022, replacing the previous practices; Helsinki mainly operated without TXA, whereas Tampere routinely used intravenous (i.v.) TXA.

Results: A total of 198 patients undergoing chest masculinization surgery were included. Among them, 9 (4.5%) major hematomas occurred. The need for reoperation due to postoperative hematoma was lower in the topical TXA (3.2%, 2 out of 63 patients) and i.v. TXA (3.4%, 2 out of 58 patients) groups compared to the non-TXA group (6.5%, 5 out of 77 patients). Subpectoral incisions (71.2%, 141 patients) resulted in a 5.0% hematoma rate, whereas periareolar incisions (28.8%, 57 cases) had a 3.5% hematoma rate.

Conclusions: Our study suggests that topical and i.v. TXA effectively reduce postoperative bleeding in chest masculinization surgeries, with similar outcomes between the 2 methods. Albeit our results lack statistical significance and they support the potential benefit of prophylactic TXA use in hematoma reduction.

Keywords: Breast surgery; Hematoma; Masculinization; Postoperative complications; Tranexamic acid; Transgender.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Surgical techniques.
Figure 2
Figure 2
Subpectoral incision and free nipple grafts; a) preoperative, b) intraoperative, c) postoperative.
Figure 3
Figure 3
Free nipple graft.
Figure 4
Figure 4
Subpectoral incision and relocation of the nipple-areola complex (NAC) with a pedicle; a) and b) intraoperative, c) postoperative.
Figure 5
Figure 5
Postoperative hematoma before evacuation.
Flowchart 1
Flowchart 1
Distribution of postoperative major hematomas among the different subgroups.
See this image and copyright information in PMC

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