How Long Do I Need to Be off Smoking After Breast Implant Surgery?

Question

I had breast augmentation 24 days ago and I know smoking is VERY important to the healing. I quit 3 weeks prior to sugery, a week before the "quit date" that I cut down to only 1 per day. I started smoking again at 3 weeks after my surgery. Now, I am just wondering if this will have an effect on my healing? My incisions look like they are coming along very well, but I still have have stitches, they are the dissolving kind. What is your opinion?    Thank you very much for your help!!

Larry S. Nichter, MD, MS, FACS · Answer

Most experts unanimously agree that smoking increases the rate of  breast augmentation surgical complications significantly - This applies both before and after your surgery. For example smoking after surgery dramatically increases your risk of having a capsular contracture (hard abnormal looking breasts).. Just about all plastic surgeons strongly recommend  women  to stop smoking and all nicotine products well in advance of breast augmentation with breast implants and not to start afterwards.  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.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  You are 100% correct that smoking can negatively affect the outcome of a surgical procedure as it can increase your risk for developing complications.  As a vasoconstrictor, nicotine compromises the amount of good and well-oxygenated blood that is delivered to your tissues.  These complications include everything from infection, wound formation, poor scarring, poor healing, development of capsular contracture and many others.  In my practice, I generally request that my patients discontinue smoking and use of all nicotine containing products for at least 4 weeks pre- and post-op.  It would be amazing if patients never smoked again following their surgical procedure, but as physicians and realists we do understand that this is generally not the case.  I would recommend that you follow up with your operating surgeon to discuss your progress to date and how resumption of and continued use of nicotine may impact your overall cosmetic result.  I wish you the best of luck on your recovery and I hope you find this helpful.

Brian K. Reedy, MD · Answer

Hi and thank you for your question.I ask my patients to stop smoking 3 weeks before and 3 weeks after surgery. If you can quit for good that would be even better! Best wishes.

Young R. Cho, MD, PhD · Answer

Thank you for your question. Smoking before or after your surgery can increase your risk of developing complications including infection and wound healing problems.  I generally ask patients to stop a couple months ahead of surgery and then for a couple months after surgery.

Jerome Edelstein, MD · Answer

It is a good idea to stay away from cigarettes for at least 2 weeks after surgery, although it is better to stop for longer if possible to facilitate your recovery because you are at a higher risk of experiencing skin loss and poor wound healing.

Lewis Albert Andres, MD · Answer

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 breast augmentation where the viability of the nipple-areolar complex is obviously important. Since the vascularity to the area is already tenuous with placement of the implant beneath, 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, and wound complications, as well as other health consequences.  The most devastating consequence of infection, especially since an implantable prosthetic device is used, is increased. This along with wound healing and scarring. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Farbod Esmailian, MD · Answer

Do not go hand in hand.  You are basically guaranteeing yourself to have issue with your health and/or your plastic surgery.
It is a fact that patients who smoke have a higher capsular contracture rate.
So eventhough you may have healed well, you are setting yourself up for problems with your surgery as well as your health.

Otto Joseph Placik, MD · Answer

STOP SMOKING FOREVER is the easiest answer. Without being sarcastic, that may save you additional cosmetic procedures at a later date. There are no definitive studies to answer your question. As long as your wounds are healing, smoking has the potential to compromise your result. However, that having been said, typically the vast majority of the scar tissue has been deposited by 3 weeks after surgery. Scar tissue can undergo a maturation process that takes up to two years.

Pablo Prichard, MD · Answer

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.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

Tom J. Pousti, MD · Answer

Thank you for the question.

	The use of nicotine (as in any form)  can lead to devastating complications after surgical procedures. Nicotine is a potent constrictor of blood vessels, preventing the delivery of oxygen etc. to surgical sites  that require good  blood flow to heal. The resulting decreased blood flow leads to potential problems with healing, tissue necrosis, open wounds,  infections…

	Don't even think about the use of nicotine around the time of your surgery.n  Ideally, you don't smoke after surgery either.

	Best wishes

How Long Do I Need to Be off Smoking After Breast Implant Surgery?

Answers (18)