Topical Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis of Postoperative Bleeding Outcomes.

BACKGROUND: Haematoma and seroma formation are recognised postoperative complications following breast surgery. Tranexamic acid (TXA), an antifibrinolytic agent widely used in other surgical specialties, has not yet been routinely adopted in breast surgery. This systematic review and meta-analysis evaluated the effect of topical TXA on postoperative outcomes in breast surgery. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase and Cochrane CENTRAL were searched from inception to February 2026 using the terms (tranexamic OR TXA) AND breast AND topical. Outcomes included postoperative haematoma, seroma and drain output. Random-effects meta-analysis was performed to calculate mean differences and risk ratios (RRs). RESULTS: Seven studies (five randomised controlled trials and two cohort studies) involving 1258 breasts (629 topical TXA and 629 controls) were included. Meta-analysis demonstrated a significant reduction in postoperative drain output with topical TXA (mean difference -16.22 mL; 95% CI: -26.54 to -5.91; p = 0.002). Topical TXA was associated with a 75% reduction in haematoma risk (RR 0.25; 95% CI: 0.08-0.72; p = 0.01). Seroma rates did not differ significantly between groups (p = 0.26). Subgroup analysis by procedure type showed numerically greater effects in mastectomy cohorts, with no significant subgroup differences for drain output (p = 0.31) or haematoma (p = 0.19). No TXA-related adverse events were reported. CONCLUSION: Topical tranexamic acid appears to be a safe adjunct in breast surgery, reducing postoperative drain output and haematoma formation. Larger, high-quality randomised controlled trials are needed to validate these findings and establish standardised protocols.