How Does Smoking Affect Breast Reduction Surgery? What if I Smoke One Cigarette a Day?

Doctor Answers 14

Smokin and surgery

The short answer to your question is that smoking before and after surgery is bad for wound healing -- even one cigarette a day is bad.  The reason is that the nicotine in cigarettes impairs blood flow to the tissues.  Surgery will also stress the blood flow to the skin along the incisions.   The combination of both surgery and smoking will jeopardize the blood flow enough that you could have skin breakdown, skin loss, or even lose your nipple after a breast reduction surgery.  As others have already told you, please stop smoking in preparation for your surgery so that you can have the best outcome possible.  Good luck!

Oklahoma City Plastic Surgeon
5.0 out of 5 stars 15 reviews

Smoking Not Recomended for any type of surgical procedure

Dear May,

Smoking one cigarette a day can be disastrous! Please do yourself a favor and abstain completely until you are a few weeks post op. Not only does nicotine deprive the tissues from blood, it also carries (along with other nutrients involved in healing) antibiotics to help fight infection. So not worth the risk!

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 180 reviews

Smoking and breast reduction

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 tell my patients that it is ideal to stop a couple months ahead of surgery and then for a couple months after surgery.

Smoking and surgery

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 37 reviews

How does smoking affect breast reduction surgery? What if I smoke one cigarette a day?

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 14 reviews

Smoking: Don't Do It!

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.

Best wishes


Smoking is an unnecessary risk during breast reduction

Smoking will rob the healing tissue of the oxygen needed to heal and is a risk to any surgical procedure. You should quit altogether three to six weeks before your reduction.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 36 reviews

No smoking after breast reduction surgery!

Tissues need oxygen from blood flow in order to survive. With a breast lift (mastopexy) or breast reduction, the tissues are rearranged in a way that reduces blood flow for a while. Nicotine from any source constricts blood vessels, further reducing blood flow. The combination of the surgery and nicotine can lead to tissue death (necrosis) even after one cigarette. It's an unnecessary risk.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 36 reviews

Smoking Can Increase Complications After Breast Reduction

Dear May in Michigan.  It is laudable that you have reduced your cigarette use to one a day, but you still are increasing your risk of complications.  The nicotine in cigarettes impairs the blood flow in small blood vessels in the skin which can result in skin necrosis (death) and wound separation. Additionally, the nipple has an increased risk of necrosis because it may be on a long piece of breast tissue (breast pedicle) and is at the end of the blood vessels.  Any decrease in blood flow in the breast pedicle places the nipple at risk for necrosis.  

Additionally, the carbon monoxide in cigarettes inhibits the delivery of oxygen to the site of wound healing and further increases risks of delayed healing.  From an overall health standpoint, you will tolerate general anesthesia better if you have abstained from smoking, as well as decrease your risk of heart and lung disease.  Most surgeons recommend that you stop smoking 4-6 weeks before and after your surgery.  It can certainly be difficult to give up smoking so you may wish to talk to your primary care doctor about smoking cessation medications and support groups.  Good luck!

Smoking and breast surgery

There are several ways to look at this question. Most plastic surgeons are going to have a policy about smoking, especially with breast surgery. There is no question that smoking even one cigarette will put you at a higher risk for complications with this procedure. And since it is a controllable variable, most plastic surgeons would advise you to stop completely before and for a period after breast reduction surgery. My policy is to stop 6 weeks before and for at least 2 weeks after surgery. That being said, I am sure there have been many patients of mine that have not followed the rules and have still had good outcomes. Some of your risk is going to be determined by the technique that your surgeon uses for the reduction as well. So the answer will always be to avoid smoking for any type of breast reduction surgery. It just doesn't make sense to increase your risk of problems. But if you were to cheat and smoke, you would most likely get away with it and not have any problems. That just wouldn't be my suggestion.

William T. Stoeckel, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 66 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.