Does Smoking Cause Open Wounds and Infection on a Breast Reduction?

I am also curious as to why I have mixed stories from different doctors in regards to smoking and the affects before and after surgery. I have talked with several plastic surgeons and yet to get a logical answer when asked if smoking was the cause or what? I have never experienced anything as painful, open wounds, infection, etc. I have always been healthy and fit and some doctors will say no smoking can restrict blood flow but was not the cause, while others will scrutinize smoking? Confused

Doctor Answers (7)

Nicotine and Breast Reduction Surgery?


You should be free of any type of nicotine product  for at least 4 to 6 weeks prior to breast reduction surgery.  This holds true for other plastic surgical procedures that involve flaps,  such as facelifting 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.

San Diego Plastic Surgeon
5.0 out of 5 stars 680 reviews

Nicotine decreases blood flow


Not the smoke part but the nicotine that constricts the blood vessles and can cause healing problems especially in surgery where the skin is widely lifted up (breast reductions, lifts, tummy tucks, facelifts).  Most surgeons would want you away from ALL nicotine products for several weeks before and after surgery including second hand smoke to minimize the healing risks.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews




Cigarette smoke contains nicotine.  Nicotine causes vasoconstriction.  Vasoconstriction causes less blood to flow into tissue.  Less blood means less oxygen.  Therefore nicotine causes less oxygen to flow into tissue.  When wounds are healing and they are pulled tight, the flaps rely on small blood vessels for oxygen.  If the small blood vessels are constricted due to nicotine, the tissues will not receive oxygen.  When tissues do not receive oxygen they break down and can cause open wounds which can secondarily become infected.  Therefore nicotine is bad for wounds. However smoking, per se, does not cause open wounds or infection, but leads to poor healing, which can cause open wounds and subsequent infection.


Thank you,






J. Timothy Katzen, MD,

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Smoking and wound healing


At a cancer center here in Houston, they will have the patient undergo a serum or urine cotinine test to see if a patient has recently used tobacco, and will cancel the surgery until the patient stops using tobacco.  Nicotine causes blood vessels to shrink In size, thus decreasing blood flow to certain areas.  When a surgery is done, whether a breast reduction or other, blood flow is lost to certain areas and has to come from another sometimes distant source.  This can potentially lead to tissue necrosis with nicotine use as the blood just can't make it through the shrunken blood vessels.

The surgeon is looking into your best interest when he or she says to not smoke, as they want you to have a good outcome from your surgical experience.

Robert Kratschmer, MD
Houston Plastic Surgeon
4.5 out of 5 stars 10 reviews

Smoking increases surgical risks

Smoking can impair wound healing based on reduced blood flow to the flaps. I do not see a basis for confusion. If you have not had this type of surgery, you cannot extrapolate by comparison to minor wounds. I recommend that you try a smoking cessation program and delay surgery until you have successfully completed it.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Smoking and surgery


Smoking increases the risks of complications with surgery.  There are some reports that it increases the risk by 50%!

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast Reduction and Smoking


In short - smoking and all nicotine products are extremely harmful to normal healing after a breast reduction.  So much so that I will not perform an operation on any patient who has been smoking or taking nicotine product for 4 weeks prior to surgery.  Having surgery has enough inherent risks and adding smoking to this list unnecessarily adds more.  Best wishes.

Brian Howard, MD
Alpharetta Plastic Surgeon
4.5 out of 5 stars 18 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.