Can necrosis occur in someone who has stopped smoking 4 weeks prior to a tummy tuck?

Question

it will be 4 weeks from the date i stopped smoking till the date of my tummy tuck and I am starting to worry about this condition. Is there anything else I can do to decrease the chances of necrosis?

Sultan Hassan, MD, FRCS(Plast) · Answer

Hi and thank you for your useful question. There is no absolute, but 4 weeks cessation pre-operatively is reasonable and I strongly advise my patients to never restart! Smoking =reduced blood flow=higher risks of dead skin/fat!

Matthew Schulman, MD · Answer

Smoking definitely can cause necrosis of the skin after a tummy tuck. This is why we all tell our patients to stop smoking before the surgery. In general, we recommend stopping all nicotine products 4-6 weeks before surgery and the same after surgery. This includes gum and electronic cigarettes!  So, while your risk may be made less if you stop smoking 4 weeks before surgery, the risk is still there. Your surgeon should modify his/her surgical techniques to reduce this chance. If you quit for longer, your risk will lower even more. You may even ant to consider postponing your surgery a month or so, so that you can be nicotine-free for 8 weeks. Just something to consider....

Pablo Prichard, MD · Answer

While not smoking 4 weeks before a tummy tuck decreases your chance for necrosis, you are still at higher risk than a non-smoker. 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. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk.  Your skin and tissue can turn black and fall off if this happens. 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. Hookah also does not decrease nicotine.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

Mark Deutsch, MD, FACS · Answer

This is a difficult question to answer. You did not mention how much you smoked or for how long. Every surgeon has his or her own protocol regarding operating on smokers (or former smokers), therefore I would advise you to discuss this with your surgeon. Additionally, you should avoid any form of nicotine delivery whether it is patches, gum, e-cigarettes, or second-hand smoke for the post-operative time frame that your surgeon requires. Hopefully your smoking cessation will become permanent. Good luck to you.

Scott E. Kasden, MD, FACS · Answer

There is some controversy regarding when to smoke to optimize safety from tt.  Some doctors will still do a tt in smokers.What is in your control is staying away from tobacco and second hand smoke.  Walk flexed at the hip.  Check with your doctor at every turn to be sure you have his blessings first.sek

Robert L. Kraft, MD, FACS · Answer

Wound necrosis could theoretically occur in any patient; smoking is one of the factors, among others, which is linked to restricted blood supply to the flaps created during the surgery.  Obviously, the longer you have abstained from products containing nicotine, the better.  E-cigarettes are not a solution as these, as well as nicotine gum, contain the same substance with a different method of delivery.  You should also refrain from smoking postoperatively.

Emily J. Kirby, MD · Answer

4 weeks is a minimum timeframe to stop smoking before surgery.  If you are flexible, you may consider pushing your surgery back a few weeks to give your body more nicotine-free time.  Be sure that you have eliminated all sources of nicotine, including gum, patches, e-cigarettes, vapor cigarettes, and even secondhand smoke.  Of course, there is no guarantee that you will be able to avoid skin/wound healing problems, but this is your best chance.  It will be important to avoid smoking after surgery for 4-6 weeks as well.  Better yet - don't every restart!  Good luck!

John P. Stratis, MD · Answer

Although the science is not completely clear you should be OK with no smoking at 4 weeks. The real danger is after the surgery. Many smokers will start to feel better after 3 to 4 days and the urge pops up and they start smoking again. That is when you can see significant necrosis to the fat, skin and belly button, even with one cigarette.That is why I have patients stop for 3 months. If they indeed stop smoking for three months they will think twice and three times before they go back to smoking after the surgery.

Rick Rosen, MD · Answer

there still is a risk, due to the effects of the nicotine on the vessels especially. 4 weeks is the minimal time to wait. necrosis still can occur, even in non smokers. discuss things with your surgeon in advance again.

Guillermo Koelliker, MD · Answer

Dear Patients:As you can see by my title it is vital to stop smoking to eliminate the possibility of necrosis.Most doctors agree with this suggstions but few demand it.   I wont operate on a patient who has been smoking for 3 months prior to surgery.   Your post op care after tummy tuck is very important.This holds true for facelift , breast procedures and lipo. We require a 14 day stay at our private spa retreat in San Migel de Allende after tummy tuck.

Can necrosis occur in someone who has stopped smoking 4 weeks prior to a tummy tuck?

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