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The use of tranexamic acid in transgender men undergoing subcutaneous mastectomy for chest masculinization

James IB, O'Brien JP, Turer DM, Grunwaldt LJ
University of Pittsburgh

Presenter: Isaac James

I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The present study represents the original work of the resident.

Director Name: Vu Nguyen

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)

Tranexamic acid (TXA) is an anti-fibrinolytic hemostatic agent that has recently become popular in plastic surgery. TXA appears to reduce hematoma and overall complication rate in oncologic breast reconstruction, but to date, minimal data exists assessing the use of TXA in transgender patients undergoing subcutaneous mastectomy.

A retrospective review of patients undergoing subcutaneous mastectomy with free nipple grafting by a single surgeon was performed. Subjects in Cohort 1 underwent surgery between May 2016 and July 2018 and did not receive TXA. Subjects in Cohort 2 underwent surgery between July 2018 and February 2020 and received a bolus of IV TXA prior to incision followed by maintenance infusion. Outcome measures included overall complication rate, hypertrophic scarring, dehiscence, hematoma, seroma, VTE, infection, and return to OR.

Sixty-two patients comprised Cohort 1, and seventy-two patients comprised Cohort 2. Demographics were similar between groups. Cohort 1 had a higher overall incidence of post-operative complications compared to Cohort 2 (14.5% vs 4.2% respectively; p=0.036). Cohort 1 also trended toward higher incidence of hematoma versus Cohort 2 (4.8% vs 0.0% respectively; p=0.096). Incidence of other complications was similar between groups. Subgroup analysis suggested that increasing surgeon experience did not account for the reduced complication rate.

IV TXA was well-tolerated in our cohort and no VTE events were reported among patients receiving TXA. The use of TXA was associated with reduced incidence of postoperative complications and a trend toward fewer hematomas. However, larger prospective studies will be necessary to corroborate our findings.

Author Contact Information:
Isaac James
3256 Ward St.
Pittsburgh, PA

3042908459 (cell)

Ohio,Pennsylvania,West Virginia,Indiana,Kentucky,Pennsylvania American Society of Plastic Surgeons

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