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Smoking Before Breast Lift?

I am scheduled for a breast lift on May 21. When I went to the doctor in March he told me I needed to be cigarette-free for 4 weeks before surgery. So, about 5 weeks ago I went from about 14-15 cigarettes a day to about 1 per day. This past week I went from 1 to nothing. Should I be ok for surgery in 1.5 weeks?

Doctor Answers 11

Talk to your surgeon, especially about the pain you're feeling

Smoking is very detrimental to the recovery process following breast lift and other surgery. It compromises your immune system making your body less effective in fighting infection. It also hinders circulation making the recovery process slower. I usually recommend my patients stop smoking about four weeks before surgery. However, if you were smoke-free for three and only smoked one cigarette, you may be okay. Please ask your surgeon for their advice.

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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 29 reviews

Smoking before breast lift?

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 any surgical procedure. Nicotine always increases the risk for infection, nipple necrosis, and wound complications, as well as other health consequences. 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 13 reviews

Stop smoking before and after a breast lift

You just never completely know about healing in smokers.  If you have been off smoking for 4 weeks prior to surgery we believe that the risks do go down.  Continue to smoke after surgery and you are asking for wound healing problems.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 11 reviews

Smoking before elective surgery - bad idea

Every surgeon has their smoking cessation protocol.  Please talk to your surgeon and be honest about your tobacco/cigarette use.  Best of luck!

Dr. Basu

Houston, TX

Smoking and breast lift

Every surgeon should have  a policy on smoking and elective surgery. You need to be honest with yours and make sure that he/she is comfortable continuing with your procedure. Even though the odds are that you would have no problems with the surgery, there really is no reason to take a risk. I would suggest postponing the surgery until you were able to be compliant with your surgeon's policy. 

William T. Stoeckel, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 49 reviews

Smoking before breast lift

I tell my patients they need to be smoke free for 3 weeks both before and after surgery. The final word should be from your own surgeon. Don't cheat or you will pay a big price.

Ronald Schuster, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 35 reviews

Smoking and breast procedures...a relative no-no.

In general, smoking is well-documented to lead to delayed wound healing problems related to all types of surgical procedures.  In the breast, this can mean damage to the vasculature supplying the nipple/areola complex as well as all lines of incisions.  The results can vary from simply delayed wound healing to gross wound dehiscence (wound coming apart) leading to contour and symmetry problems.  Sometimes, secondary procedures are required to revise the non-healing areas.  Also, fat necrosis can be a problem following breast procedures in smokers, which can lead to infection or firm lumps in the breast.  I, too, recommend smoking cessation well in advance (at least 4 weeks) prior to any procedure, especially for breast and body.  You certainly should not pick up smoking for at least 6 weeks following your procedure, assuming an uneventful postoperative period.

Andre Panossian, MD, FACS
Pasadena Plastic Surgeon
5.0 out of 5 stars 1 review

Smoking and breast surgery

This is a good question with varying answers.  My group's protocol now is to do in-office testing to see whether nicotine metabolites are still detectable.  This has been a helpful guide to us.  Speak to your surgeon about your concerns.  Good luck!

Smoking before Breast Lift?

You will need to inform your plastic surgeon of your situation. Only he  will be able to make the decision whether or not to proceed with surgery. Otherwise, you will receive a variety of online opinions;  none of them may be specific/relevant given that every plastic surgeon may have a different practice.

Best wishes.

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.