Abstract

Background: Gynecomastia surgery generally yields reliable chest contouring results. Perioperative bleeding sequelae (blood-stained lipoaspirate, drain burden, ecchymosis, and hematoma) remain clinically relevant and may delay recovery. Antifibrinolytic tranexamic acid (TXA) is routinely used in major surgeries to decrease blood loss and transfusions. Its use in gynecomastia surgery is limited.

Objective: To evaluate the efficacy of different tranexamic acid (TXA) application methods in controlling perioperative bleeding in gynecomastia surgery.

Patients and Methods: In a prospective, randomized, controlled trial at Assiut University Hospital (Assiut, Egypt), 48 males with true gynecomastia (16-45 years; BMI <35 kg/m²) underwent suction-assisted liposuction with selective glandular excision were randomized (1:1:1; n=16/group) to: Group A (standard tumescence), Group B (local TXA: 500 mg added to tumescence), or Group C (IV TXA: 500 mg, maximum 15 mg/kg). The primary endpoint was estimated intraoperative blood content of the lipoaspirate; key secondary endpoints were postoperative drain output and duration, ecchymosis (incidence and maximal extent), operative time, length of stay, and early complications over 6 weeks. One-way ANOVA with appropriate post-hoc testing and chi-square/Fisher tests were used (two-tailed P<0.05).

Results: Intraoperative aspirate blood content differed significantly across groups (P<0.001) and was lowest with local TXA (control 375.00±40.82 mL; local TXA 190.63±20.16 mL; IV TXA 341.25±37.04 mL). Drain output favoured local TXA (65.63±15.04 mL vs 41.88±11.09 mL vs 55.00±5.16 mL; P<0.001) with shorter drain duration (4.19±0.91 vs 3.19±0.40 vs 3.38±0.50 days; P<0.001). Ecchymosis extent was smaller with local TXA (6.19±2.01 vs 1.10±1.10 vs 2.10±1.20 cm; P<0.001), while ecchymosis incidence was numerically lower with local TXA (37.5% vs 6.25% vs 12.5%; P=0.057). Operative time differed modestly (98.75±7.19 vs 104.38±9.64 vs 106.25±8.06 minutes; P=0.039). Early complications were infrequent and did not differ significantly between groups (P=0.210).

Conclusion: Adjunctive TXA improved bleeding-related recovery surrogates in adult gynecomastia surgery, with local TXA in the tumescent solution providing the most consistent reductions in intraoperative aspirate blood content and drain burden. TXA also reduced the extent, with a non-significant trend toward fewer ecchymoses. Larger trials are warranted to define clinical benefit and safety.