Background <p>Tranexamic acid (TXA) is increasingly used in plastic surgery because of its effectiveness in reducing perioperative bleeding and enhancing recovery owing to its antifibrinolytic properties. We conducted a systematic review and meta-analysis to investigate TXA efficacy and safety in plastic breast surgery.</p> Methods <p>A comprehensive literature search was performed using PubMed, Embase, Web of Science, and Cochrane CENTRAL databases, covering their inception period to the present and targeting randomized clinical trials and observational studies that met the predefined inclusion and exclusion criteria. Studies were screened for relevance, and data extraction focused on crucial variables. Effect estimates were pooled using random-effects models. The results are presented as odds ratios and corresponding 95% confidence intervals for primary (hematoma and seroma) and secondary (infection and duration of hospital stay) outcomes.</p> Results <p>Eighteen studies involving 3,445 patients were included in the final meta-analysis. TXA administration caused substantial reductions in hematoma and seroma formation and notably reduced total hospital stay duration. No thromboembolic events or other serious complications were reported.</p> Conclusion <p>The evidence from this study suggests that perioperative TXA administration significantly reduces the risk of complications in plastic breast surgery and shortens hospital stays, improving patient outcomes and resource utilization. Notably, the risk of thromboembolic events remains unchanged, validating TXA’s safety and underscoring its value in standard perioperative protocols for plastic breast surgery procedures.</p> Level of Evidence I <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>