Why do BL+BA Patients have to quit smoking at least 2 weeks before surgery?

I am a smoker, and have been for about 6 years. I used to smoke 2 packs a day about a year ago...then slowly cut down to one...and finally to about 3 a days in the past 2 months (not bad I think...but not GREAT). I have my surgery for a BL and BA scheduled in 10 days exactly. Everything I have read states that nicotine leaves the system in 3 days. I know that nicotine is the problem...so if it leaves the body in 3 days...why are we asked to quit at least 2 weeks before?

Doctor Answers 11

No Smoking prior to surgery

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The no reason to stop smoking two weeks prior to surgery is because smoking interferes  with wound healing and increase the risk of complications.

San Francisco Plastic Surgeon

Stop smoking prior to surgery

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There are several reasons to stop smoking prior to surgery.  The first is to avoid pulmonary complications such as pneumonia.  With a breast lift, there is the concern of smoking affecting the circulation to the nipples which could result in loss of circulation to the nipples, which would be a major problem.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 28 reviews

Smoking and surgery

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Nicotine is one of many problematic compounds in cigarette smoke.  There are over three thousand chemicals in smoke, many that affect circulation and oxygen transport, like carbon monoxide. Two weeks is the minimum amount of time one should obstain completely from smoking. Smoking will lead to a 25% risk of complications, including tissue necrosis (think about your nipples), poor wound healing, infection, and poor scaring. 
Dont kid yourself into thinking it's ok. 
Best of luck. 

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 97 reviews


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Smoking causes vasoconstriction which impairs wound healing. I recommend to quit 1 month prior to surgery. 

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 314 reviews

Why do BL+BA Patients have to quit smoking at least 2 weeks before surgery?

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Thank you for the question.
The use of nicotine (as in any form) can lead to devastating complications after surgical procedures. Nicotine is a potent constrictor of blood vessels, preventing the delivery of oxygen etc. to surgical sites that require good blood flow to heal. The resulting decreased blood flow leads to potential problems with healing, tissue necrosis, open wounds, infections…Let your plastic surgeon know that you are continuing to smoke; in my opinion, moving ahead with surgery does expose you to significant risk. Best wishes.

Why quit smoking before plastic surgery?

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Your question is simple, but the answer complex.  First, you don't "need" to quit smoking.  You can smoke right up until your procedure.  Tobacco consumption however significantly increases your chance of surgical and non-surgical complications and adverse outcomes.  The best treatment for these problems is prevention.  Once they happen, you cannot turn the clock back.  You are stuck with a new problem that will prevent you from enjoying your breasts.  You may be miserable, in pain, and need to manage smelly draining wounds for weeks or months.  Remember, your surgeon's sutures simply immobilize skin edges together transiently, until they resorb.  During this time, your body is producing structural collagen to replace those stitches, and hold your body together.  If smoking has impaired your capacity for collagen production (as products of tobacco combustion do), your sutures may dissolve and their tensile strength disappear before your body has sufficiently healed to hold your wounds together.  You'll be disappointed, and so will your surgeon, as you both helplessly observe progressive dehiscence of the closure, settling back down of your breasts, and confront the new reality of daily open wound management, diminished sexuality, delayed return to activities of daily living (e.g. sports and fitness), not to mention the financial impact of further surgery.

There's more, but you get the point.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 47 reviews

Prolonged vasoconstriction

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I agree with the other answers. Any surgery can have slow healing and increased risk of necrosis and wound infection due to the vasoconstriction and lack of circulation. Breast aug with a lift is safely done  but was particularly known as a risky procedure due to the risk of skin and nipple necrosis and dehiscence. Most recommend 3-4 weeks before a breast reduction or lift and some advocate checking a urine nicotine level before surgery to ensure it is all out of there system.

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Why do BL + BA Patients have to quit smoking at least two weeks before surgery?

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Nicotine, carbon monoxide, along with multiple other chemicals in cigarette smoke, contribute to both vasoconstriction and decreased oxygenation carrying capacity of the hemoglobin.  Studies have shown that these effect can be significantly reversed by ceasing smoking. However, it can take up to six weeks to fully reverse these effects.  Now is a great time to quit smoking completely.  Best wishes, Dr. Lepore.  

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 59 reviews

Smoking risks

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Smoking is discouraged prior to any surgery requiring anesthesia because it increases the risk of anesthesia, immediate post operative coughing when emerging from anesthesia can cause bleeding and nicotine and carbon monoxide causes a drop in oxygen delivery to healing tissues. 
That said, in general the risks of smoking are overstated because of a general disapproval of smoking in the medical community and rigid guidelines for cessation of smoking are unnecessary for routine breast surgery where the risk of bleeding is small and tissue vascularity is not questionable. Good luck to you and try to quit anyway!

Joel Aronowitz, MD
Los Angeles Plastic Surgeon

Nicotine and wound healing

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Nicotine is a vasoconstrictor, meaning that every time you have a cigarette the small blood vessels that are necessary for wound healing shrink. Although nicotine may leave your body in a few days, the effects on the blood vessels last several weeks – and in most studies patients are required to stop smoking at least three weeks prior to surgery in order to reduce their risk. Most surgeons performing any breast surgery where an implant is placed or incisions are placed on the breast will NOT operate on a person who is actively smoking. 

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.