{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:02:58Z","timestamp":1789783378415,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010analysis evaluated the effect of topical TXA on postoperative outcomes in breast surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis 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\u2010effects meta\u2010analysis was performed to calculate mean differences and risk ratios (RRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven studies (five randomised controlled trials and two cohort studies) involving 1258 breasts (629 topical TXA and 629 controls) were included. Meta\u2010analysis demonstrated a significant reduction in postoperative drain output with topical TXA (mean difference \u221216.22\u2009mL; 95% CI: \u221226.54 to \u22125.91;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Topical TXA was associated with a 75% reduction in haematoma risk (RR 0.25; 95% CI: 0.08\u20130.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Seroma rates did not differ significantly between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.26). Subgroup analysis by procedure type showed numerically greater effects in mastectomy cohorts, with no significant subgroup differences for drain output (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31) or haematoma (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.19). No TXA\u2010related adverse events were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Topical tranexamic acid appears to be a safe adjunct in breast surgery, reducing postoperative drain output and haematoma formation. Larger, high\u2010quality randomised controlled trials are needed to validate these findings and establish standardised protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70968","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:17:16Z","timestamp":1789780636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Topical Tranexamic Acid in Breast Surgery: A Systematic Review and Meta\u2010Analysis of Postoperative Bleeding Outcomes"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4610-4611","authenticated-orcid":false,"given":"Sina","family":"Sobhanmanesh","sequence":"first","affiliation":[{"name":"Department of Surgery Nepean Hospital  Kingswood New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-0088","authenticated-orcid":false,"given":"Femi E.","family":"Ayeni","sequence":"additional","affiliation":[{"name":"Department of Surgery Nepean Hospital  Kingswood New South Wales Australia"},{"name":"Nepean Institute of Academic Surgery, Nepean Clinical School The University of Sydney  Kingswood New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8098-7583","authenticated-orcid":false,"given":"Deborah S. M.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Surgery Nepean Hospital  Kingswood New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"1","key":"e_1_2_14_2_1","first-page":"87","article-title":"Complications Related to Breast Reconstruction After Mastectomy Using Multiple Surgical Techniques\u2014A National and International Comparative Analysis","volume":"60","author":"Marinescu S. A.","year":"2019","journal-title":"Romanian Journal of Morphology and Embryology"},{"issue":"6","key":"e_1_2_14_3_1","first-page":"795","article-title":"Clinical Use of Tranexamic Acid: Evidences and Controversies","volume":"72","author":"Colomina M. 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Global Open"},{"issue":"4","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1097\/PRS.0000000000010322","article-title":"Topical Tranexamic Acid in Breast Reconstruction: A Double\u2010Blind Randomized Controlled Trial","volume":"152","author":"Safran T.","year":"2023","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/01.GOX.0000937744.24824.d2","article-title":"Topical Tranexamic Acid Does Not Reduce the Incidence of Hematoma in Reduction Mammoplasty: A Double\u2010Blinded, Randomized Placebo\u2010Controlled Trial","volume":"11","author":"Yao A.","year":"2023","journal-title":"Plastic and Reconstructive Surgery \u2010 Global Open"},{"key":"e_1_2_14_11_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"366","author":"Sterne J. 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