How Long Before Surgery Should I Stop Nicotine Replacement Therapy?

I quit smoking almost a year a go. Recently, I've been going through stress and had the urge to smoke again. Instead of smoking, I started back on NRT. I use the Nicorette lozenges, about 3-4/day. How soon before surgery should I stop?

Doctor Answers 21

NRT and Mommy Makeover Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Since you asked the question, you must be aware that smoking increases the risk of some complications for surgery including wound healing. Congratulations on quitting almost a year ago! Available evidence does not support a detrimental effect of NRT in surgical patients, especially when compared with the consequences of continued smoking. However, I advise my patients not to take anything other than vitamins prior to surgery. I like to see them avoid anything unnecessary for two weeks before and two weeks after surgery. Good luck.


San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Stop Smoking and NRT 8 weeks before Mommy Makeover

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Generally Plastic Surgeons recommend stopping all forms of Nicotine 5 weeks before surgery.

However Mommy Makeover is a "Multiple Procedure" operation which carries increased post operative risks and I prefer that all forms of Nicotine be stopped 8 weeks before Mommy Makeover Surgery.

I also recommend doing blood tests to check for Nicotine metabolites in the blood before surgery.

The Mommy Makeover typically includes a Tummy Tuck, and Breast surgery either Breast Augmentation, Breast Lift or both. These multiple procedures involve creating skin flaps which lessen the blood supply to the skin.

Since Nicotine causes spasm of blood vessels and reduced blood supply to the skin, the effects of Nicotine can be very risky during Mommy Makeover surgery

Nicotine before surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Smoking 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 patient 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.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

You might also like...

After surgery is an important time...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I applaud your efforts with stopping smoking.Your health overall will benefit from that change! Unfortunately when we are worried about healing for surgery, the nicotine is the problem.Nicotine causes the tiny blood vessels in the skin and tissue to constrict, and this stops the blood flow to the areas that are trying to heal.Without blood flow wounds just cannot heal properly.Patients who smoke or use NRT after surgery often experience delayed healing, wound breakdown, and end up with worse scars and a less than optimal result.The most important time to be nicotine free is from the date of surgery until about 3-4 weeks afterward, but given the addictive nature of nicotine you will want to stop using NRT at least a few weeks before that so that you are safely done by the time of surgery and not tempted to cheat (and risk harming your results).It doesn’t usually work to quit cold turkey the day of surgery… that would just add more stress for you while you are trying to heal and recuperate from surgery!Also remember that second hand smoke can be just as dangerous to you as you smoking yourself… so avoid second hand exposure for at least 3 weeks after surgery too.Good luck with your procedure.

Smoking & Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I tell my patients no nicotine for 4-6 weeks before AND after surgery. It can delay the healing process. Congratulations on quitting smoking!

Michael A. Fiorillo, MD
New York Plastic Surgeon
4.9 out of 5 stars 107 reviews

Quitting nicotine before and after surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Congratulations on quitting smoking! Most plastic surgeons recommend that you quit all nicotine containing products 4-6 weeks prior and after surgery. The reason is simple. Nicotine causes the small blood vessel to narrow decreasing the much need blood supply to the healing tissues after surgery. You and your plastic surgeon wan the BEST outcome for you. Nicotine  in the bloodstream decreases the oxygen and nutrients to getting delivered to the tissues. A patient who has residual nicotine will have a higher rate of complications such as infection, wounds falling apart and worse. What ever you can do to stop all nicotine products 4-6 weeks prior and after surgery will help tremendously, Best of Luck.

Mary Jo Wright, MD
El Paso Plastic Surgeon
5.0 out of 5 stars 9 reviews

Nicotine and surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question.  Congratulations on quitting smoking.  Nicotine causes constriction of the very small blood vessels which supply oxygen, nutrients, and healing factors to all of the tissues of the body.  The result of this is a significant impediment to the ability to heal wounds and fight local infection.  For this reason, it is the recommendation of the American Board of Plastic Surgery that patients stop all nicotine-containing products for at least 1 month before and 1 month following elective surgery.

How long before surgery should I stop nicotine replacement therapy?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Breaking the habit of cigarette smoking is very difficult. Congratulations on your success. The nicotine component of cigarettes and other nicotine supplements constrict small blood vessels in the skin. This constriction can diminish the blood flow to the skin and create wound healing problems. This can be a significant problem in different components of the Mommy Make Over. If a tummy tuck is performed a long incision is made in the lower abdomen. This diminishes the blood flow to the upper edge of the incision. When the skin and fat layer is then elevated off of the underlying muscle additional decrease in blood flow to the edge results. This diminished blood flow combined with the constricting effects of nicotine can lead to death of the skin of the lower abdomen leaving a large open area that requires many months for closure to occur. Even after the wound is healed the resultant scar can be quite large and permanent. When a breast lift is performed as a part of the Mommy Make Over an incision is made around the areola, which is the dark skin surrounding the nipple. This incision takes away some of the blood flow to the nipple and the areola. The nicotine can cause constriction of the remaining blood vessels and lead to death of the nipple areolar complex. The edges of the breast lift incisions are also at risk for the same problem. For these reasons we normally recommend patient's refrain from any type of nicotine products for 6 weeks before the surgery and 4 weeks after.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 133 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would recommend stopping at least 4-6 weeks prior to elective surgery to allow time for vascular recovery and decrease the risk of healing problems or tissue loss.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

How long before surgery should I stop nicotine replacement therapy?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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 mommy makeover where the viability of the skin/tissue, belly button, and 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 and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, nipple necrosis, poor scarring, and wound complications, as well as other health consequences including blood clots. The anesthesia risk is greater with general anesthesia as well as pulmonary issues/lung infections postoperatively. 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 28 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.