How long will it take for nicotine/cotinine to get out of my system so I can pass the test?

Question

Hi, I'm preparing for my TT and breast lift. I pretty much quit smoking about 8 weeks ago with the exception of maybe one night a week when I was drinking. Over Thanksgiving I did give in and smoke about half a pack a day for a couple of days. Now I'm back to not smoking. I have preop 11 days from last cig and surgery 13 days after that. I know I pushed it to much but how long does it really take to get the nicotine and cotinine out of my system and pass the test ?

Ryan E. Austin, MD · Answer

Hi, thanks for your question. We typically recommend that you quit smoking at least 2 months before your surgery and for 2 months following your surgery. It's not really so much about passing a test, it's primarily about smoking inhibiting healing, and also about your lungs being irritated before you are put under general anesthesia. If your lungs and airway are irritated before you go under general anesthesia they could be overreactive and you risk going into what is called bronchoconstriction or simply put spasms. So you really want to be upfront with your surgeon about not only your smoking (how much you've smoked and when), but also about your alcohol consumption, which also has a bearing on the cocktail of drugs that you are administered before you go under. Please speak to you surgeon about this and any other concerns that you might have.

Brian K. Reedy, MD · Answer

Hi & thanks for your question!
You should completely stop smoking 3 weeks prior to surgery. You may be okay with 2 weeks. Contact your surgeon regarding his or her guidelines regarding this. Best of luck!

Jeffrey M. Darrow, MD · Answer

“Pretty much quitting” smoking but still smoking half a pack for several days is not truly quitting smoking. If you are going to undergo an elective cosmetic surgery, which you are financially responsible for, it only makes sense to be sure that you are absolutely maximized to the best of your ability, so the risk of complications is minimized.  That would mean no use of nicotine in any fashion: smoking, gum, lozenges, nasal spray, patch, etc, for a minimum of 3 weeks before your surgery.  it would also be important to take into account the cumulative years that you have smoked because patients who have been heavy smokers for several decades have some underlying damage to their blood vessels. You should speak in detail about this with your plastic surgeon to determine the best way and safest way forward for you. Best wishes.

Frederick W. Ehret, MD · Answer

Thank you for your question. TBH, I'm not really sure how long you need to be nicotine free to pass "the test". However, that's not what you should really be worried about. Your main concern should be making sure your nicotine free for an adequate length of time for your surgery. The absolute minimum time you should be nicotine free before your surgery is two weeks, but longer would be safer. Nicotine is a very powerful vasoconstrictor (cuts off blood flow). That can mean the difference between a good result when you're nicotine free and an absolute disaster when you have nicotine in your system before surgery. By absolute disaster, I'm referring to your nipple turning black, dying and falling off. If this scares you a little bit, you should be. Being nicotine free for surgery is the one thing you can easily control to give yourself the best chance for a good outcome.
If you're trying to take it down to the wire just so you can pass the test, you're only cheating yourself (particularly your nipples and belly button).

Christine Rodgers, MD · Answer

HI Polite,

I am answering you in a polite way so please take this in the spirit of wanting you to have the best outcome from your surgery. Passing the test is not the issue. Having the surgery in a safe manner with the best outcome possible is the real objective here and hiding the fact from your doc that you are still smoking does not demonstrate a real commitment to obtaining the best results and to the surgeon who is trying her/his best to help you.
  Perhaps you need to decide what is more important to you - smoking or having a healthy and excellent result from your surgery. I hate to tell you this, but the effects of smoking do not wear off completely in 2 weeks. The small blood vessels that have been narrowed by your smoking will not get better in such a short time, if ever. You are only making things worse by sneaking cigarettes.
  Be fair to your doctor and to yourself and tell you surgeon what you have done and let her/him decide what is the best course of action for you.

Good luck,

Dr. Christine Rodgers

Kenneth Hughes, MD · Answer

Generally, nicotine leaves your blood 1-3 days after you stop using tobacco. However, for the patient to return to more normal respiratory and immune system function, smoking cessation should occur at least a month prior to surgery. 
In addition to the wound healing complications, nicotine and its compounds can lead to poor scarring and higher scar revision rates. Smokers have a 50% higher rate of fluid collections (seromas), which can distort and totally destroy a very nice cosmetic result after liposuction or similar body contouring procedures. The most serious complication of cigarette smoke to the plastic surgery itself is the death of tissues, known as tissue necrosis. A piece of skin dissected can literally die, yielding an open wound that can create a very long healing period and a poor result. Rather than hope that the nicotine will not show up in your lab work prior to surgery, be honest and tell your PS your most recent smoking events.

John LoMonaco, MD, FACS · Answer

Rather than worry about the test, start by being honest with your surgeon about when you last smoked and how much. The goal is not to "pass the test" it is to have a safe surgery and avoid wound healing problems that can ruin your results.

Nelson Castillo, MD · Answer

Typically I would allow for at least 6-8 weeks so you may want to discuss this with your surgeon in anticipation of your procedure.

Daniel Barrett, MD · Answer

Dear Polite132824,
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

Robert M. Tornambe, MD · Answer

I appreciate your frustrations and concerns about quitting smoking before and after your surgery, however it is a big deal! Smoking, specifically nicotine, causes constriction of blood vessels and can seriously affect healing. That means possible wound disruption and ugly scarring!
I advise my patients to stop smoking for at least two weeks before and two weeks after surgery to prevent problems with healing. The nicotine test should not be an issue for you because it measures nicotine in your bloodstream over the last 24 to 48 hours. It is in your best interest to quit smoking before and after your surgery as you are having the surgery to look better, and most certainly want to achieve the best possible result. Good luck.

How long will it take for nicotine/cotinine to get out of my system so I can pass the test?

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