Why do different surgens have different time lines for quitting nicotine before surgery?

I quit smoking cigarettes one year ago but have been using nicotine gum since then, one to two pieces a day. I have scheduled a tummy tuck in 30 days and have stopped chewing the gum but I'm concerned that 30 days of being nicotine free is not enough time before my surgery to prevent complications. Why do some surgens say six weeks and others only two?

Doctor Answers 10

Quitting nicotine before surgery

Using tobacco brings a significant risk of cancer, stroke, heat attack, etc. From a Plastic Surgery standpoint it is a vasoconstrictor. Wound healing is all about getting oxygen and needed entities to the wound. It is well known that patients who smoke have a tremendous increase in their rate of serious complications, (infections, wounds falling apart, etc.). Nicotine is the main vasoconstrictor, so getting a patch or lozenge of nicotine won't help the vasoconstriction. Best to be off the tobacco/nicotine entirely before surgery. Please be honest with your Board Certified Plastic Surgeon. Together you can make a plan to quit and proceed with surgery. The amount of time between quitting and surgery will depend on the Plastic Surgeon and the procedure.


Las Vegas Plastic Surgeon
4.6 out of 5 stars 16 reviews

Nicotine abstinence

When I reviewed the literature on this subject, the figure that I saw was two months, but that was not a prospective controlled trial.  What is equally important is postoperative smoking.  We test patients for nicotine one month prior to the procedure and then the morning of the procedure.  Problems have occurred when the patient resumes smoking after the procedure.  Quitting before is not enough, whether it is 4 weeks or 8 weeks.  We are not trying to be mean or judgmental with the nicotine, we just don't want you to have a nasty open wound. 

Also, nicotine ages you likely nothing else.  

Alan Muskett, MD
Billings Plastic Surgeon
5.0 out of 5 stars 9 reviews

Good question

30 days is generally enough time to be off nicotine.  However, 6 weeks is probably safer.  People metabolize chemicals at different rates. If there is any concern perform a urine cotinine test day of surgery.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 31 reviews

For six different answers, all you need to do is talk to two plastic surgeons.

That's the running joke, but it's more accurate than we might prefer.

Your experience in discovering the difference between the recommended time off nicotine before a tummy tuck is highlighting what we call "the Art of Medicine".  In those gray areas where there are not any absolutes, we all practice based on our own biases, preferences, superstitions, experiences, and what we think the most accurate research indicates.  This is the Art:).

If your tummy tuck is already scheduled, I'd proceed with the recommendation of the surgeon that you are planning on having perform your surgery.  He or she is the best one to give you advice.  

It sounds like maybe you question their instructions about your surgical care, so perhaps you need to rethink things a bit.  Should you feel that their advice is not something you can trust, then either you need to reevaluate whether you are able to put yourself in a better position to accept their guidance.  Or, perhaps, you need to consider another surgeon.

Ultimately, you need to get on the same page as your surgeon or hold off on things.

Best of luck.

Why do different surgeons have different time lines for quitting nicotine before surgery?

Hi and thanks for your question. The simple answer is that there are no controlled studies that have looked at wound complications associated with length of time patients have discontinued nicotine use. However, most plastic surgeons recommend that patients avoid nicotine usage for at least 4-6 weeks prior to surgery. Best of luck with your upcoming surgery.

Richard Chaffoo, MD, FACS, FICS
Triple Board Certified Plastic Surgeon

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.7 out of 5 stars 16 reviews

Cessation of nicotine intake preop to reduce wound complications---When is long enough?

Several procedures pose more risk than others for wound healing issues making the attendant risks proportional.  Some procedures have not only greater risk but the magnitude of resulting wound issues can lead to protracted wound care with associated emotional and financial burdens.  For example a partial necrosis of a portion of your abdominal flap may take months of wound care before healing and that with more scar burden. Then, of course, there can be just different physician opinions based on their own experience.  There is no absolute answer to your question but generally the longer period of abstinence from nicotine intake should minimize your risk. Best Wishes 

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 23 reviews

Nicotine

Nicotine in any form will inhibit wound healing and increase complication rates.  While 2 weeks seems to be the standard, the longer you quit before surgery the better.  30 days should be more than enough.  Good luck with your upcoming procedure.

Why do different surgeons have different time lines for quitting nicotine before surgery?

Thank you for your question. Every surgeon will have their own guidelines for nicotine. The more amount of time without nicotine the better. 

All the best, 

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Stopping smoking is the right choice

The sooner you stop smoking the better off you are; this means no nicotine regardless of form or intake route. I insist on 1 month of no smoking; I used to also check nicotine levels on the day of surgery to make sure you were negative. Nicotine levels are supposed to be undetectable after  one month of quitting. Hope this helps. Please also see link below to get your free cheat sheet "7 keys to a great tummy tuck."

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 44 reviews

Nicotine & Surgery

Every surgeon has his or her own pre-op protocol. Two weeks of no smoking, no nicotine is the minimum. If you can do longer then that's always a good idea. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 51 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.