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 (9)

Nicotine and Breast Reduction Surgery?

+2

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 751 reviews

Nicotine decreases blood flow

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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 49 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. This is especially bad in breast reductions or face lifts. 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

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Does smoking cause open wounds and infection on a breast reduction?

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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 and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, nipple necrosis, poor scarring, and wound complications, as well as other health consequences including blood clots. The anesthesia risk is greater with general anesthesia as well as pulmonary issues/lung infections postoperatively. 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

SMOKING SLOWS DOWN HEALING OF WOUNDS

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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 27 reviews

Smoking and wound healing

+1

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

+1
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 12 reviews

Smoking and surgery

+1

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 17 reviews

Breast Reduction and Smoking

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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.