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Tummy Tuck Recovery and Necrosis Risk Due to Smoking?

I have a Tummy Tuck scheduled in 7 wks. I used to be a smoker for many years but now only smoke socially (10 a month if that). I smoked a few the other day and I am concerned about skin necrosis because of that and my history of smoking.

I am 34, very healthy, and in great shape. I have loose skin and separation of muscles from pregnancy. I am also wondering how the recovery is in comparison to c-section, I have had 2 (very easy). I will not smoke anymore but am concerned about my past and risks.

Doctor Answers 20

Smokikng and wound healing problems

An area of marginal necrosis in the middle is not uncommon. This is the area that is the furthest away from the blood supply and under the most tension.  Smokers are at greatest risk but this can happen to anyone.    

Atlanta Plastic Surgeon
4.5 out of 5 stars 12 reviews

Smoking is Dangerous for Tummy Tuck Patients

First of all even a social or "occasional smoker" is still a smoker and this brings real risks to your surgery. Discuss your risk factors such as your smoking history candidly with your plastic surgeon and ask for his advice and recommendations.

Most experts unanimously agree that smoking increases the risk of most surgical complications significantly. This especially applies to all  lifting such as a tummy tuck procedure that you are scheduled to have done. Just about all plastic surgeons strongly recommend women to stop smoking and all nicotine products well in advance of all plastic surgery and especially lift procedures..  Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.
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 constrict ( spasm or  tighten up). Over time, these constricted arteries and capillaries deliver less blood to the tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as tissue sloughing (death by necrosis) and infection.  General complications of surgery such as blood clots (deep venous thrombosis) which can travel to your lungs (pulmonary embolus), anesthetic problems such as pneumonia are also increased.
A recent 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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 63 reviews

Smoking is a risk to tummy tuck

Smoking has long been recognized as a risk in tummy tuck, and does indeed lead to healing problems for an unfortunate few.

The nicotine causes the skin to be robbed of oxygen, and constricts the small blood vessels to the skin. These two effects lead to breakdown of the incision, or can result in ulceration in the skin, also called tissue necrosis.

After such a big investment in your health and appearance you owe it to yourself to stop smoking at a minimum of two weeks before tummy tuck, and four weeks is even better. Even if the the risk is low it is not worth taking so stop now, rest and exercise to focus your energy on a smooth recovery.

Best of luck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 34 reviews

Tummy Tuck Recovery and Necrosis Risk Due to Smoking?

 Avoid nicotine nicotine in all its "modalities' of delivery. It is a powerful constrictor of blood vessels,  decreasing blood flow to the “flaps” used during these procedures. This decreased blood flow could potentially lead to wound healing problems and/or tissue necrosis. Best advice: avoid nicotine completely or postpone surgery.

Best wishes. 

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. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. 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

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 36 reviews

Tummy tuck recovery and necrosis risk due to smoking?

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 tummy tuck where the viability of the 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 belly button, 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. 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 and tummy tuck

I advise all my tummy tuck patients who are smokers to quit smoking for at least 6 weeks before and after surgery. Even patients who are only "light smokers" or "social smokers" are at significant risk of having complications such as wound healing problems, skin necrosis, poor scarring, etc. It's always better to be safe than sorry. 

I suggest you have an honest conversation with your plastic surgeon and wish you all the best!

Tummy tuck hurts less than c section.

With your history, tummy tuck should be very safe. You don't smoke much, and you will not have smoked at all for seven weeks. You should recover quickly and well.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Smoking and Tummy Tuck

Studies have shown that one cigarette can reduce the amount of oxygen in the tissues for up to 4 hours. With continued cigarette use you can imagine the deoxygenation that can occur. This effect does not diminish immediately after cessation of smoking.

But take heart. The fact that you don't smoke regularly is a good thing. You're 7 weeks away from surgery so you should be fine. As long as your surgeon doesn't place too much pressure on the incision or do liposuction in the wrong areas you'll be fine.

Cigarette smoking is very detrimental to soft tissues because of the over 100 different chemical found in them. So if you're willing to spend significant money on cosmetic surgery then you should at least stop smoking to decrease the untoward effects of tobacco.

Stop smoking to lower risks with tummy tuck and other procedures

Dear Amo,

You sound like a person who is otherwise a good candidate for abdominoplasty / tummy tuck, and would likely have a good experience and nice improvement. Most importantly, you recognize the importance of ceasing smoking (and nicotine products) at least 3-4 weeks prior to surgery.

The other important factor is that you pick an experienced, board-certified plastic surgeon. Your surgeon will likely adapt the technique used in order to reduce risks as well.

Discuss the recovery with your surgeon and his / her staff for more details. Without further discussion with you, it is difficult to compare recovery to a C-section.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.5 out of 5 stars 3 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.