Will Smoking Hookah Negatively Effect my Nipples During Surgery?

During breast reduction surgery will my nipples die if I have smoked hookah during 3 times during the past six months. I know the nurse said if I smoked there would be a risk but I never thought about it like this until I was at the hookah bar. Someone please help me because I am freaking out and I am scared. I've never smoked cigarettes or anything else in my entire life!

Doctor Answers (8)

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.  Hookah also does not decrease nicotine.
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


Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

Will smoking hookah negatively affect my nipple during surgery?

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Hello! Thank you for your question! The issue with nicotine and any inhalant 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 a breast procedure 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 Hookah Before / After Surgery

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The centuries old custom of smoking Water pipes / Nargila / Hookahs is spread throughout the Asia and North Africa and has spread into Europe and the Americas. While the tobacco smoke is flavored by a collection of flavors and is cooled by travelling through cold water it is NOT less hazardous to your general health. As a matter of fact, hookah smokes contains 36 TIMES the amount of tar as does cigarette smoke. In addition to tar, you will STILL be exposed to 4,000 chemicals, including 43 known cancer-causing chemicals and 400 other toxins. including  nicotine, and carbon monoxide among others. Nicotine causes severe and prolonged closure of blood vessels which may starve skin of oxygen. As a result, smokers, first or second hand are much more likely to suffer wound separation, fat death and nipple losses after surgery.

Speak with your surgeon.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

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Nicotine Before Breast Reduction?

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Thank you for the question.

Nicotine ( of any kind) is a vasoconstrictor and can lead to problems with blood flow to tissues and resulting wound healing problems. Furthermore, blood flow to the nipple/areola may be compromised during breast reduction surgery. Any form of nicotine usage should be stopped at least one month prior to surgery.

Best wishes.

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Nicotine is never good before surgery...

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Normally when having surgery it is recommended to stop smoking four weeks before and two weeks after surgery to aviod complications.  The nicotine in cigarettes or hookah constricts blood vessels which can affect healing especially in procedures like breast reduction or tummy tuck.  The fact that you are not an everyday smoker and only smoked hookah three times should not effect your healing process as long as it has been more than one month.  It is always best not to smoke anymore of it for health reasons.  If you have any other questions or concerns I would contact your surgeon.

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Breast Reduction and Smoking

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You should be fine, three times should not have any effect, however patients are warned that they should not smoke at all 2 weeks before and 2 weeks after surgery as it can cause complications. And then we hope if a patient has stopped smoking for those 4 weeks they won't start again! Good Luck!

Miguel Delgado, Jr., MD
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Smoking marijuana 3 times in 6 months will not increase the risks of breast reduction.

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Occasional smoking of anything is really not harmful and will not jeopardize the viability of a nipple at the time of breast reduction.  Chronic smokers should stop several weeks before surgery to minimize the risks of the operation.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
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You should be ok

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There is not much information specifically regarding hookah use and breast surgery. But you have done this only occasionally and i believe you should be ok. But it would not be a good idea to use the hookah the night before your surgery. Talk to your surgeon about this and he/she would agree that this is a very small risk the way you have descibed it.

Bala S. Chandrasekhar, MD - RETIRED
Los Angeles Plastic Surgeon

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.