How Long Before Surgery Should I Stop Nicotine Replacement Therapy?

I quit smoking almost a year a go. Recently, I've been going through stress and had the urge to smoke again. Instead of smoking, I started back on NRT. I use the Nicorette lozenges, about 3-4/day. How soon before surgery should I stop?

Doctor Answers 18

NRT and Mommy Makeover Surgery

Since you asked the question, you must be aware that smoking increases the risk of some complications for surgery including wound healing. Congratulations on quitting almost a year ago! Available evidence does not support a detrimental effect of NRT in surgical patients, especially when compared with the consequences of continued smoking. However, I advise my patients not to take anything other than vitamins prior to surgery. I like to see them avoid anything unnecessary for two weeks before and two weeks after surgery. Good luck.


San Francisco Plastic Surgeon
5.0 out of 5 stars 54 reviews

Stop Smoking and NRT 8 weeks before Mommy Makeover

Generally Plastic Surgeons recommend stopping all forms of Nicotine 5 weeks before surgery.

However Mommy Makeover is a "Multiple Procedure" operation which carries increased post operative risks and I prefer that all forms of Nicotine be stopped 8 weeks before Mommy Makeover Surgery.

I also recommend doing blood tests to check for Nicotine metabolites in the blood before surgery.

The Mommy Makeover typically includes a Tummy Tuck, and Breast surgery either Breast Augmentation, Breast Lift or both. These multiple procedures involve creating skin flaps which lessen the blood supply to the skin.

Since Nicotine causes spasm of blood vessels and reduced blood supply to the skin, the effects of Nicotine can be very risky during Mommy Makeover surgery

Smoking & Surgery

I tell my patients no nicotine for 4-6 weeks before AND after surgery. It can delay the healing process. Congratulations on quitting smoking!

Michael A. Fiorillo, MD
New York Plastic Surgeon
5.0 out of 5 stars 66 reviews

How long before surgery should I stop nicotine replacement therapy?

Breaking the habit of cigarette smoking is very difficult. Congratulations on your success. The nicotine component of cigarettes and other nicotine supplements constrict small blood vessels in the skin. This constriction can diminish the blood flow to the skin and create wound healing problems. This can be a significant problem in different components of the Mommy Make Over. If a tummy tuck is performed a long incision is made in the lower abdomen. This diminishes the blood flow to the upper edge of the incision. When the skin and fat layer is then elevated off of the underlying muscle additional decrease in blood flow to the edge results. This diminished blood flow combined with the constricting effects of nicotine can lead to death of the skin of the lower abdomen leaving a large open area that requires many months for closure to occur. Even after the wound is healed the resultant scar can be quite large and permanent. When a breast lift is performed as a part of the Mommy Make Over an incision is made around the areola, which is the dark skin surrounding the nipple. This incision takes away some of the blood flow to the nipple and the areola. The nicotine can cause constriction of the remaining blood vessels and lead to death of the nipple areolar complex. The edges of the breast lift incisions are also at risk for the same problem. For these reasons we normally recommend patient's refrain from any type of nicotine products for 6 weeks before the surgery and 4 weeks after.

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 91 reviews

After surgery is an important time...

I applaud your efforts with stopping smoking.Your health overall will benefit from that change! Unfortunately when we are worried about healing for surgery, the nicotine is the problem.Nicotine causes the tiny blood vessels in the skin and tissue to constrict, and this stops the blood flow to the areas that are trying to heal.Without blood flow wounds just cannot heal properly.Patients who smoke or use NRT after surgery often experience delayed healing, wound breakdown, and end up with worse scars and a less than optimal result.The most important time to be nicotine free is from the date of surgery until about 3-4 weeks afterward, but given the addictive nature of nicotine you will want to stop using NRT at least a few weeks before that so that you are safely done by the time of surgery and not tempted to cheat (and risk harming your results).It doesn’t usually work to quit cold turkey the day of surgery… that would just add more stress for you while you are trying to heal and recuperate from surgery!Also remember that second hand smoke can be just as dangerous to you as you smoking yourself… so avoid second hand exposure for at least 3 weeks after surgery too.Good luck with your procedure.


I would recommend stopping at least 4-6 weeks prior to elective surgery to allow time for vascular recovery and decrease the risk of healing problems or tissue loss.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 26 reviews

How long before surgery should I stop nicotine replacement therapy?

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 mommy makeover where the viability of the skin/tissue, belly button, and 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 14 reviews

Nicotine cessation

I recommend no nicotine for two weeks prior to and two weeks after surgery. Nicotine causes your blood vessels to squeeze down, which decreases the oxygen available to your tissues for healing. I commend you for going back to lozenges instead of smoking. It's a tough habit to kick - congratulations.

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 96 reviews

Nicotine and Surgery

Nicotine causes vasoconstriction of blood vessels which results in decreased blood flow to the skin. Any procedure that requires the elevation of skin flaps can be adversely impacted by this phenomenon. For this reason we generally recommend that patients not use nicotine products for four to six weeks prior to surgery. This includes cigarettes, nicorette gum, patches or anything else that contains nicotine.


         It’s important to understand that every patient’s situation is unique. For this reason, this approach may require modification from time to time based on the patients particular needs. Under these circumstances it’s always important to consider the patients risk benefit ratio. 


It is best to stop all nicotine containing products and cigarettes 4 weeks prior to elective cosmetic surgery.

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.