Why Do I Have to Stop Smoking for a Breast Lift?

I have had several surgerys in the past and healed just fine so why is a breast lift any different 2 doctors told me they would not have to move or down size my nipples if I do smoke what could happen

Doctor Answers 11

Nicotine = blood vessel narrowing = distant tissue death and wound separation

No medical condition in the history of the universe has profited doctors and undertakers more than Nicotine (and the hundreds of other toxins in cigarettes). Nicotine has been proven to directly or indirectly cause hundreds of diseases and conditions including, heart disease, PAD with loss of toes and feet, high blood pressure, COPD, asthma, bronchitis, lung cancer, skin damage, impotence etc etc.

When as Plastic surgeons we undermine a large area of the skin, we greatly depend on an intact circulation within that skin flap to continue carrying oxygen to the very edges and bring about healing. In smokers, the blood vessels are in a prolonged state of spasm and flow through the skin is poor. As a result, certain operations such as Facelifts, Tummy Tucks, Breast Lift, Thigh Lifts etc which depend on this circulation have poor if not disastrous results in smokers.

If you are unwilling to give up smoking to both look better and remain healthy, please, do not have the surgery. Do not lie to your surgeon or go to a surgeon who does not care about your smoking status - you may end up looking much worse.

Memphis Plastic Surgeon
5.0 out of 5 stars 85 reviews

Smoking and breast lift

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

Why do I have to stop smoking for a 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 16 reviews

Breast Lifting and Nicotine?

Nicotine is constrictor of blood vessels,  decreasing blood flow to tissues that need to flow to heal after surgery. When plastic surgeons do operations that involve longer incisions and/or tissue flaps,  the blood flow to these areas become critical. Without the blood flow ( or a decreased blood flow secondary to the effects of nicotine) healing can be compromised and/or tissue may not survive.

For this reason, most plastic surgeons will not operate on patients who smoke within a time period prior to surgery (for specific operations such as facelifting, breast lifting, tummy tuck surgery etc.).

I hope this helps.

Smoking and surgery

Smoking should be stopped about 3-4 weeks prior to surgery and continued for 3-4 weeks after surgery until all wounds have healed.  Smoking increases complication rates by almost 50% as reported in some medical studies.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Wound healing with smoking is like growing a plant without water.

A breast lift requires lifting of the skin which limits the blood supply to the skin. The nicotine and carbon monoxide int tobacco smoke compromise the already limited blood supply making tissue death and wound separation at least 50 times more likely. Wound healing with compromised blood supply is like trying to grow a plant in the desert. It is in your best interests to stop smoking and shows that your surgeon is exercising good judgment.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

Smoking and surgery

Smoking causes constriction of the blood vessels. In many surgeries this really does not matter much since there is usually an abundance of blood vessels feeding each area. However, in procedures like a breast lift where the surgery itself reduces the blood supply to the tissuse, smoking will reduce the remaining blood supply and can do so enough to cause enough decrease that the nipple or parts of the skin dies.

For this operation, continuing to smoke raises the risk of tissue (including nipple) loss 20 fold. Most Plastic Surgeons are not willing to take this chance, even if you are.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Smokers have increased risk of wound complications when undergoing cosmetic surgery

Smoking and chemicals in cigarette smoke tighten small blood vessels and decrease blood flow to healing tissues. A breast lift involves cutting the breast and skin and moving the nipple to a higher position on the breast.  Blood supply is partially cut during this procedure so healing depends on the adequacy of the blood flow left behind.  Cigarette smoking increases the risk that this blood supply will not be adequate, increasing the risk of wound breakdown, nipple loss and loss of breast tissue and skin. Breast lift is a non medically indicated surgery, and as such, should be done only when risks of complications are minimal. I am glad that there were no complications with your previous medically indicated surgeries, but you were lucky. Smoking may increase the risks of elective surgery to unacceptable levels. I would counsel you to quit before surgery just as your surgeon has already done.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 47 reviews

Smoking and plastic surgery carries specific risks

Breast lifts, tummy tucks, and facelifts all have something in common which is underminig the skin and pulling it into a new position. These 2 factors put strain on the blood flow to the skin, and if you add a blood vessel constrictor drug such as nicotine the blood flow to that area can shut down completely. The result is dead tissue, which can be a horrendous problem. Surgeries that don't involves this sort of extra strain on blood circulation to the skin in the surgical site can heal OK in smokers. But in the case of a breast lift, it is a specific and unacceptable risk. An analogy I like to use is crossing the street when there is traffic; with smoking it is like stepping out in front of an oncoming truck instead of waiting for the green light (quitting smoking.)

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 38 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.