Use of Plant-Based Absorbable Hemostatic Powder and Intravenous Tranexamic Acid in Breast Reduction Patients Reduces Hematoma Rates.

Abstract

Reduction mammaplasty is an effective treatment for symptomatic macromastia but is associated with postoperative complications, such as hematoma, seroma, and infection. Tranexamic acid (TXA) has been shown to reduce blood loss and hematoma formation across surgical specialties, whereas the efficacy of adjunctive topical agents like Arista, a microporous polysaccharide hemostat, remains uncertain in breast surgery. This study evaluates whether combining TXA with Arista confers additional benefit in reducing postoperative complications following reduction mammaplasty. A retrospective cohort study was conducted on patients undergoing bilateral reduction mammaplasty at a single institution from January 1, 2020, to April 1, 2025. Patients were divided into 3 groups: those receiving both IV TXA and topical Arista (n = 120), TXA alone (n = 133), and neither agent (control, n = 211). The primary outcome was hematoma incidence, stratified into major (requiring reoperation) and minor. Secondary outcomes included seroma, infection, and delayed wound healing. Statistical analyses included ANOVA and chi-squared tests with significance set at P < 0.05. A total of 464 patients were included in this study; 120 consecutive breast reduction patients received both Arista and TXA, 133 patients received TXA only, and 211 controls received neither. Combined use of TXA and Arista resulted in the lowest total hematoma rate (2.5%), compared to TXA alone (3.8%) and control (10.0%; P < 0.05). Major hematoma rates were significantly reduced in both treatment groups compared to control but did not differ significantly between TXA (2.3%) and TXA + Arista (1.7%). Infection rates were lowest in the combination group (0.8%) versus TXA alone (6.8%) and control (2.8%; P < 0.05). Delayed wound healing was also reduced with combined treatment (1.7%) compared to TXA alone (16.5%) and control (11.4%; P < 0.0005). Seroma rates and estimated blood loss showed no significant differences across groups. IV TXA significantly reduces postoperative hematoma rates following reduction mammaplasty, with the addition of Arista providing a modest incremental benefit. Although TXA remains the primary agent for hematoma prophylaxis, Arista may be selectively useful in patients contraindicated for TXA. Further prospective studies are warranted.