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Should Breast Lift and Augmentation Be Postponed Because of Smoking?

I just quit smoking. My Breast lift and Breast implant surgery is in 9 days. Should I postpone my surgery?

Doctor Answers (15)

Tell your surgeon

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Your Breathing
Smokers are more likely to experience breathing problems following surgery than non-smokers (40% compared to 11%) because tobacco smoke damages the lining of the lungs. When the lungs are compromised, they are less efficient in clearing away waste (secretions and particles). This, coupled with the decreased efficacy of a smoker's immune system, can lead to post-operative infections and/or pneumonia.

Your Heart
The nicotine in cigarettes affects nervous systems, leading to faster heart rates (heart stress) and high blood pressure. Combined with the carbon monoxide present in tobacco smoke, a substance that reduces the body's ability to transport oxygen to the heart, smokers become much more susceptible to heart attacks (at a rate of 80% higher than non-smokers). Heart stress is also much more commonly witnessed by anaesthesiologists.

Infections
A smoker's compromised immune system leads to a rate of post-operative wound infection that is six times higher than non-smokers.

Fortunately, patients who stop smoking before surgery are able to protect themselves from many of the complications that can occur during their procedure. Taking this precaution reduces surgical risks and may help create a more successful treatment outcome.

Cigarette smoke contains carbon monoxide that reduces the ability of the red blood cells in a smoker's body from transporting oxygen throughout the body. The presence of carbon monoxide in the blood is reduced by half when no cigarettes are smoked for four hours and, better yet, is reduced to a safe level if cigarettes are avoided for eight hours. Stopping smoking before and after surgery helps oxygen to more effectively travel throughout the body, an essential tool in warding off infection and successful wound healing.

If patients do not stop smoking for at least 4 weeks before surgery, their surgery may be rescheduled. Please tell your surgeon that you've just stopped 9 days ago.


Toronto Plastic Surgeon
5.0 out of 5 stars 63 reviews

Smoking and surgery

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Here are the major points of smoking Tobacco or Marijuana before or after surgery:
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 28 reviews

Should breast lift and augmentation be postponed because of smoking?

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Hello! Thank you for your question! The issue with nicotine is that it also acts as a vasoconstrictor, clamping down of blood vessels. Blood supply is always of great concern during any surgical procedure, but especially in such a procedure as a mastopexy where the viability of the nipple-areolar complex is obviously important. Since the vascularity to the area is already tenuous since it will be raised by cutting around the area, maximizing blood flow to the tissue is critical.

Typically, we recommend at least 6 weeks of smoking cessation prior to any surgical procedure. Nicotine always increases the risk for infection, nipple necrosis, and wound complications, as well as other health consequences. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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Surgical Timing after Smoking Stopped

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The quick answer is that you will lower your risk of complications if you stop smoking at least a few months prior to surgery so you might want to consider rescheduling. Another way of putting this is: "Tell me, do you feel lucky?"
Most experts unanimously agree that smoking increases the rate of  breast augmentation surgical complications significantly. Just about all plastic surgeons strongly recommend  women  to stop smoking and all nicotine products well in advance of breast augmentation with breast implants.  Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.A scientific article in the Archives of Internal Medicine indicated that, among all forms of surgery, quitting smoking eight weeks prior was never associated with an increased risk of complications.
Here is the reason why: the nicotine in cigarettes and other tobacco products (including Nicorette gum, patches, etc) is a vasoconstrictor, meaning it makes the Smoking is a significant multiplier of many potential complications following surgery and breast augmentation with implants are no exception. Nicotine from smoking causes blood vessels to vasoconstrict ( tighten up). Over time, these constricted arteries and capillaries deliver less blood to the breast tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as infection, and in particular capsular contracture (hardening and distortion of the implants). General complications of surgery such as blood clots, anesthetic problems such as pneumonia are also increased. For a tummy tuck there is increased likelihood of both an infection and loss of skin because of inadequate circulation.
In young patients you will probably statistically avoid these complications, why tempt fate by increasing your odds that something bad will happen. .On a long term basis, smoking also causes accelerated aging of the skin and loss of elasticity. Hopefully these reasons will help give you the will power and courage to stop smoking.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Smoking before Breast Augmentation/Lifting?

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You should be free of any type of nicotine product  for at least 4 to 6 weeks prior to breast augmentation/ mastopexy surgery.  This holds true for other plastic surgical procedures that involve flaps,  such as facelift thing and tummy tuck surgery.

Nicotine behaves as a vasoconstrictor of blood vessels thereby decreasing blood flow to tissues ( that need to receive blood flow to heal after surgery).  A decrease in this blood flow may result in wound healing problems and/or tissue death.

I hope this helps

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

Smoking and surgery

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I do not like to operate on smoker's because of the increased risk of significant complications. It is best to stop 3-4 weeks prior and stay off during the recovery periond for 3-4 weeks.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Complications from smoking increase significantly for breast augmentation and breast lift

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Hi,

You should definitely postpone your surgery. At the minimum, you should discontinue tobacco use for at least 4 weeks prior to surgery. Why? Nicotine and other chemicals in cigarettes significantly increase the risk of wound healing complications. In combination with breast lift, which involves significant undermining and tightening of breast tissue, and breast implant placement, which puts pressure on the undersurface of the breast skin, complications from tobacco usage can be catastrophic. The most severe complications include loss of the nipple and areola and implant exposure, requiring removal.

All cosmetic surgery involves some kind of risk/benefit analysis. The potential risks from tobacco use outweigh the potential benefits of breast augmentation and lift.

Hope this helps. Best of luck.

Sam Jejurikar, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 31 reviews

Avoid smoking about one month prior to Aug/Masto

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Smoking increases the risks of surgery. Healing in particular is adversely affected in smokers. There are several different types of breast lift. Most involve creating skin flaps that are sewen together under the breasts. This is usually where the healing problems occur.

Almost everyone agrees that smoking can cause healing problems. It is not clear, however, how long to stop smoking prior to having a procedure. I think many plastic surgeons suggest stopping a month before surgery. I agree with this.

Remember, second hand smoke can also affect your healing. Your should avoid being around anyone else who is smoking before and immediately after the surgery as well.

James H. Schmidt, MD
Sarasota Plastic Surgeon
5.0 out of 5 stars 5 reviews

Avoid smoking for four weeks before augmentation/mastopexy

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I do not believe that 9 days off nicotine is enough time before an augmentation/lift done at the same time. I do not know what incisions are planned, but the more incisions and skin removal, the higher your risk. Postponing the surgery for an additional 20 days would give you 4 weeks off cigarettes/nicotine and I would strongly advise you to postpone. There is no upside to proceeding and there is a major potential downside.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast Lifing, Augmentation, Recovery

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Deear Cdo

There is increased risk with smokers in all surgeries. Even with cesation of smoking you have an elevated risk over non- smokers. There is no definitive prescribed timeline for reduction of risk. Splitting up the surgery into 2 procedures/days is an option.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.