Reducing Capsular Contracture in Breast Augmentation: The Role of Topical Tranexamic Acid
Introduction
Breast augmentation mammaplasty (BAM) continues to be one of the most commonly performed cosmetic procedures worldwide. However, complications such as postoperative bleeding and capsular contracture remain concerns for both surgeons and patients. A recent study published in the Aesthetic Surgery Journal explores the use of topical tranexamic acid (TXA) in BAM surgery and its effects on short- and long-term outcomes.
Surgical advancements in aesthetic procedures have led to the exploration of pharmacological agents that could improve patient outcomes. One such agent, TXA, has been widely studied for its hemostatic properties in various surgical specialties, but its role in cosmetic breast surgery is still under investigation. This review provides an in-depth analysis of the study, its implications, and how TXA could shape the future of breast augmentation surgery.
Background
Capsular contracture is one of the most frequent complications in breast augmentation, often requiring revision surgery. Previous research has indicated that postoperative bleeding can increase the likelihood of capsular contracture. TXA, an antifibrinolytic agent commonly used in orthopedic and cardiac surgeries, has been gaining attention for its ability to reduce perioperative bleeding.
Breast augmentation patients seek long-lasting, aesthetically pleasing results with minimal complications. However, postoperative bleeding and seroma formation can contribute to inflammation and fibrosis, ultimately leading to capsular contracture. The ability to control bleeding during surgery may significantly impact patient satisfaction and the longevity of the implants. Given these considerations, TXA has emerged as a promising solution.
Study Overview
Conducted by a team of plastic surgeons from Australia and the Philippines, this study retrospectively examined 288 patients who underwent primary BAM with the use of topical TXA. Patients were followed for at least five years to assess complications, reoperation rates, and long-term outcomes.
The study was designed to determine whether the use of TXA could reduce intraoperative bleeding, postoperative complications, and long-term issues such as capsular contracture. The authors followed a standardized protocol for TXA application, ensuring that all patients received the same dosage and administration technique. The study’s robust follow-up period adds significant weight to its findings.
Key Findings
- None of the patients developed postoperative hematoma, a significant benefit given the usual incidence rate of up to 6%.
- Only 0.3% of patients developed capsular contracture, significantly lower than the general rate of 10.6%.
- Complications requiring reoperation were minimal, with 1% of patients experiencing rippling, 0.7% requiring pocket revision, and 0.3% experiencing implant rupture.
- TXA was administered in two rounds as a topical spray before implant insertion, enhancing its distribution within the implant pocket.
- The study did not find an increased risk of thromboembolic complications, further supporting TXA’s safety profile.
The findings suggest that TXA is effective in reducing postoperative complications, thereby improving patient outcomes. Given that hematomas and seromas are closely linked to capsular contracture, TXA’s ability to prevent these issues could make it a valuable tool in breast augmentation surgery.
Discussion
The findings of this study reinforce TXA’s role in reducing bleeding and capsular contracture in breast augmentation surgery. By maintaining a clear surgical field and preventing small bleeds, TXA potentially lowers the inflammatory response that contributes to complications. While this study is limited by its retrospective design and lack of a control group, it provides compelling evidence supporting the use of TXA in BAM. Future multicenter studies with larger cohorts and prospective methodologies would be beneficial in confirming these findings.
TXA has been widely used in other surgical fields, particularly in orthopedic and cardiac surgery, where its benefits in reducing blood loss have been well-documented. In plastic surgery, TXA has also been used in rhinoplasty, rhytidectomy (facelift), and liposuction, with studies showing reduced intraoperative bleeding and faster recovery times. ( click to learn about breast implant augmentation recovery)
One of the potential advantages of TXA is its anti-inflammatory properties, which may help reduce the incidence of capsular contracture. Capsular contracture occurs when excessive fibrosis forms around the breast implant, leading to hardening and distortion of the breast. The exact cause is multifactorial, but reducing postoperative bleeding and inflammation may play a crucial role in prevention.
Additionally, TXA may have a role in reducing biofilm formation, another potential factor in capsular contracture. Biofilms are bacterial colonies that can form on the surface of implants, leading to chronic low-grade inflammation. By reducing inflammation and bleeding, TXA could help mitigate the conditions that favor biofilm formation.
Conclusion
Topical TXA appears to be a valuable addition to breast augmentation surgery, offering benefits such as reduced bleeding, lower rates of capsular contracture, and fewer complications requiring reoperation. Given its affordability and availability, TXA could become a standard adjunct in BAM surgery, pending further validation through larger studies.
The findings of this study are promising, but additional research is needed to confirm TXA’s long-term benefits. Randomized controlled trials comparing TXA-treated patients with non-TXA-treated patients would help establish definitive conclusions. However, based on current evidence, TXA presents a safe and effective option for improving breast augmentation outcomes.
Key Highlights
| Aspect | Findings |
|---|---|
| Study Design | Retrospective cohort study, 288 patients |
| Intervention | Topical TXA spray before implant insertion |
| Follow-up Period | At least 5 years |
| Hematoma Rate | 0% (compared to usual 0.2–5.7%) |
| Capsular Contracture Rate | 0.3% (compared to usual ~10.6%) |
| Reoperation Rate | 2.4%, mostly for aesthetic adjustments |
| Thromboembolic Events | None reported |
| Clinical Implications | TXA may reduce bleeding, hematoma, and capsular contracture risk |
Top 5 Questions About Breast Implants and Long-Term Results
1. How long do breast implants last, and will I need replacement?
Breast implants are not lifetime devices. While some may last 10-20 years or longer, others may require replacement sooner due to complications such as rupture, capsular contracture, or aesthetic concerns. Regular follow-ups with your surgeon are recommended to monitor their condition.
2. What are the risks of capsular contracture, and how can it be prevented?
Capsular contracture occurs when scar tissue around the implant tightens, leading to firmness, discomfort, or distortion of the breast shape. Prevention strategies include meticulous surgical techniques, antibiotic irrigation, and possibly the use of tranexamic acid (TXA) to minimize inflammation and bleeding.
3. Can breast implants cause health problems over time?
Most women tolerate breast implants well, but some report symptoms such as fatigue, joint pain, and brain fog, known as Breast Implant Illness (BII). Although not scientifically proven, some women opt for implant removal if symptoms persist. Additionally, textured implants have been linked to a rare cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), though the risk is low.
4. Will my breast implants sag over time?
Yes, like natural breasts, implants can sag due to aging, gravity, weight fluctuations, or pregnancy. To maintain results, patients can consider supportive bras, maintaining a stable weight, and in some cases, a breast lift (mastopexy) in the future.
5. How can I ensure the best long-term results with breast implants?
To maintain long-term results:
- Follow post-surgery care instructions carefully.
- Get routine breast exams and imaging (MRI or ultrasound) every few years to check implant integrity.
- Maintain a healthy lifestyle and avoid smoking.
- Consult your surgeon if you experience pain, swelling, or changes in breast shape.
References
Lonie, S., Abesamis, G.M., Law, J., Mohaghegh, M.H., Vickery, K., Deva, A., & Tavakoli, K. (2024). Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes. Aesthetic Surgery Journal, 44(1), NP23–NP27. DOI: 10.1093/asj/sjad219