Grants We Funded

Abstract

Impact Statement: Breast reduction mammoplasty is one of the most commonly performed procedures in plastic surgery. One known complication is postoperative hematoma. Postoperative hematomas greatly increase patient morbidity both in the acute and long-term setting. Use of the antifibrinolytic agent tranexamic acid (TXA) has consistently been shown to decrease perioperative blood loss and need for transfusion, without increasing thromboembolic events, while being highly cost-effective across multiple surgical subspecialties. Despite these known benefits, TXA has not yet been widely incorporated in plastic surgery. Greater understanding of TXA in plastic surgery has the potential to meaningfully improve patient outcomes, while decreasing surgical morbidity and associated healthcare costs.

Project Summary: Prevention of perioperative blood loss is a chief consideration in plastic surgery. Breast reduction mammoplasty (BRM) is one of the most commonly performed procedures in plastic surgery, with over 100,000 performed in the United States in 2019 alone. Postoperative hematomas are among the most frequent complications following BRM, with a reported incidence between 0.3-7% in the literature. Many of these hematomas require blood transfusions and/or urgent surgical evacuation to avoid the consequent wound healing issues arising from increased tension on the closure. Tranexamic acid (TXA) has emerged in the literature as a promising agent that reduces perioperative blood loss and need for transfusion. TXA is an antifibrinolytic agent that acts by stabilizing clot formation, and may be administered intravenously, orally, or topically. Topical administration of TXA has been shown to be as efficacious as intravenous dosing, though with substantially less systemic absorption. Multiple randomized controlled trials have demonstrated that TXA significantly reduces intraoperative bleeding and need for subsequent blood transfusion, without an increased risk of thromboembolic events. Moreover, TXA has been shown to be cost-effective in the surgical setting, not only by reducing direct hospital costs (drug and blood products), but also by decreasing subsequent costs by shortening length of stay and lowering the incidence of complications. However, the use of TXA in plastic surgery has not been well described. We propose a prospective, double-blinded randomized controlled trial study of the efficacy of TXA in patients undergoing BRM. Our primary outcome variable will be the rate of hematoma development. Our secondary outcome variables will be total drain output, rate of blood transfusion, incidence of deep venous thrombosis, and rate of thromboembolic events. We will also collect a broad range of preoperative variables, surgical details, and other characteristics that may impact the perioperative bleeding risk. We hypothesize that use of TXA will decrease perioperative hematoma formation and transfusion rates following reduction mammoplasty without increasing the incidence of thromboembolic events. Better understanding of the effect of TXA in reduction mammoplasty may be of great utility to the field of plastic surgery.

Biography
Amy Yao, MD is a plastic surgery resident at Montefiore Medical Center in the Bronx, New York. She graduated summa cum laude from St. Lawrence University with honors in Biology before obtaining her medical degree at the Icahn School of Medicine at Mount Sinai in 2018, graduating with Distinction in Research. She is interested in surgical and patient-reported outcomes following breast reconstruction. Amy has presented her research both regionally and nationally and has co-authored over 20 peer reviewed publications and abstracts.