Stopped smoking 5 weeks before my breast lift, am I still high risk for nipple necrosis?

Question

Stopped smoking my nicotine ecig 5 weeks before my breast lift. I am absolutely terrified of getting nipple necrosis, if i’m high risk I rather postpone it further. I am 22, rather heathy besides the fact that I smoke. I read more up on nipple necrosis tonight and I am sick to my stomach. Don’t want to go through with this if I will end up losing my nipples. My plastic surgeon told me i only need 2 weeks to quit before but won’t go over in detail the risks with me.

Irena Karanetz, MD · Answer

Hi, Thank you for the question. 
Smoking is a known risk factor for increased complications with surgery, because nicotine and other toxins in tobacco products can cause damage and constriction of blood vessels. This can in turn decrease the blood supply to healing tissue and increase the risk of wound breakdown, skin loss, healing complications and nipple loss (partial of full-thickness nipple necrosis).
When planning to undergo elective plastic surgery, a smoking cessation period of at least four to six weeks BEFORE surgery and AFTER surgery has been recommended. Some physicians will also do a nicotine test prior to surgery to ensure that the patient has been compliant and it is safe to proceed with surgery. Not only will smoking cessation help with reducing surgical complications and increasing the ability for wounds to heal, but it will also benefit patient’s overall well-being.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Michal Brichacek, MD · Answer

I normally ask my patients to stop smoking for four weeks before and after breast surgery to minimize the risk of complications. At that point, your risk should be similar to anyone else. What is a larger predictor of nipple necrosis is your anatomy. If your nipple is extremely far down to start with, your risk is much higher. Poor surgical technique is another factor, as nipple necrosis could occur in any patient if poor planning and surgery is performed. I would recommend seeing a board certified plastic surgeon.

Daniel Barrett, MD · Answer

Dear cdorre,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Farhad Rafizadeh, MD · Answer

Cigarette smoking has two effects on skin circulation and healing after surgery. 1) The nicotine effect subsides after a week. 2) Carbon monoxide: This poison gas that one inhales with cigarette smoke,  reduces the ability of your red blood cells to carry oxygen to the tissues and therefore can interfere with proper healing. This will require at least a month to get out of your system.

Connie Hiers, MD, FACS · Answer

You still are at risk just because you smoked. Your skin is not normal nonsmoker's skin in just only 5 weeks. However, you have a better chance of avoiding problems from smoking. Please do not restart.

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