Smoking Before Plastic Surgery?

I had a consultation today for a Breast Augmentation and a Tummy Tuck. The doctor said that I would need to stop smoking 6 weeks before surgery. Is that true? I've researched all over the Internet and people are saying 2, 3, maybe 4 weeks. I'm kind of confused and don't know what is right.

Doctor Answers 10

Absolutely the longer the better....

Hi there-

The critical thing for you to understand is that your surgeon recommended this time period to you not because he or she did not want to operate on you, but because they are concerned for your safety, and they want to maximize the probability that you will achieve the great outcome and smooth recovery you want.

The longer you go without nicotine, the better the chances will be that you will indeed get this desired smooth recovery free from complications and with a beautiful outcome at the end.

There is no question that cessation of smoking for a few weeks before surgery would lower your risks, but there should also be no question that if you were to abstain for a longer period the risk would be even lower.

Your surgeon was correct in his/her recommendation.

Listen to your surgeon

I would echo Dr. Rand's thoughts. There is no doubt that nicotine of any kind will inhibit your body's ability to heal, in particular a procedure such as a tummy tuck. You should take your doc's advice very seriously-- in may cases, once patients are forced to quit nicotine in order to have a procedure they really want, after the procedure they see no reason to restart the smoking. In other words, they use it as a powerful motivator to quit smoking for good, which does wonders for their health.

In summary: listen to your surgeon, don't use nicotine products of any kind, and use this as a chance to get off of the nicotine forever!

Good luck,

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 122 reviews

The longer the better...

Make a commitment to yourself to have the best possible outcome possible and don't skimp. These surgeries are a big financial and emotional investment. If you can't stop smoking, don't have surgery. If you try and cheat, please don't blame your surgeon for any complications because he/she is trying to protect you. We all take problems after surgery very personally and don't want anything bad to happen to anyone! I say 4 weeks minimum for a tummy tuck and if I find that they are cheating - I cancel surgery. It's THAT IMPORTANT!

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 8 reviews

At least 4 weeks before and 4 weeks after away from all nicotine

Your doctor is only trying to help you avoid a disastrous complication from your tummy tuck (not the augmentation). When you are exposed to nicotine in any form (cigarettes, gums, patches, second hand smoke) your skin circulation is compromised such that doing a tummy tuck, beast lift or facelift can result is serious complications.

I am not going to candy coat the problem here because I want you to clearly understand what can happen if you don't comply with this. The skin will die, turn black, slough off, smell horrible and potentially get infected. It will take many months to heal this open wound because the tummy tuck is closed under tension and the scar can never be revised and the result will look horrible.

So please respect your doctor's request - it is for your own good and do not short change it or cheat on it!

Smoking before surgery

2 weeks is probably enough time but most doctors allow a bit more time to allow the patient to commit to their non-smoking regimen.

The nicotine and toxins are out of the system fairly quickly, but the desire to have a cigarette may not be. Therefore a buffer zone is a good policy.

Although there are studies for and against this concept, I believe chronic smokers, even patients who have quit recently, still have an increased incidence of complications.

Smoking causes greatly increased complication rates, decreased ability to resist infections, greater incidence of anesthetic complications such as pneumonia because the cilia in the tracheobronchial tree are poisoned by cigarettes. Cigarettes have nicotine in them, a powerful vasoconstrictor. This causes shrinking of blood vessels, reduced blood supply, and reduced wound healing.

Patients who smoke shortly after facelift surgery or tummy tuck surgery can have disastrous results.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 118 reviews

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. 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

Smoking before plastic surgery?

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 procedures as breast procedures and a tummy tuck where the viability of the nipple, belly button, and skin flaps are obviously important. Since the vascularity to the area is already tenuous with the dissection of the abdominal tissue as well as cutting around the areas, 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, skin flap necrosis, and wound complications, as well as other health consequences. There is an increase pulmonary risk with the anesthesia and postop lung infections. The most devastating consequence of infection, especially since the tissue is tightened, is increased. This along with wound healing and scarring. Some surgeons will refuse to operate on smokers and often check urine or blood levels prior. 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

2 Weeks Before, 2 Weeks After in my practice.

Thank you for your question! I get this quite a bit from smokers. Personally, I am "thrilled" about operations on patients who DO NOT SMOKE. The risks depend on other health and the specific procedure. In my practice I advise to not smoke two (2) weeks prior and two (2) weeks post-operation. I recommend quitting to all of my patients and provide assist with Chantix, etc. or refer to a professional who specializes in quitting smoking.

Frank L. Stile, MD
Las Vegas Plastic Surgeon
5.0 out of 5 stars 30 reviews

Smoking and Plastic Surgery

Most experts unanimously agree that smoking increases the rate of  breast augmentation surgical complications significantly. Just about all plastic surgeons strongly recommend  women  to stop smoking and all nicotine products well in advance of breast augmentation with breast implants.  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.


Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 72 reviews

Better safe than sorry

The by products of tobacco smoke undoubtedly cause a decrease in blodd flow in smaller blood vessels that are carrying oxygen, nutrients and antibiotics to your healing tissues. Although I have my patients stop smoking or have any exposure to any tobacco products for two weeks before most surgeies, I would be happier if they stopped earlier or quit altogether. You simply increase your risks of complications by continuing to smoke around the time of surgery.

Dr Edwards

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.