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

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?

Doctor Answers 14

Advice re Smoking and tummy tuck

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

London Plastic Surgeon

Necrosis risks with tt

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


Wound necrosis in a smoker

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

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It's a good question but I don't know if there's an exact answer.  Use of tobacco is known to increase the risks of this (and other) surgery because if the impact on the blood flow.  Chemicals (such as those in tobacco) or conditions (such as diabetes or small vessel disease) that decrease the amount of blood flow in tissue will correspondingly increase the risk of necrosis and wound healing problems.  Stopping four weeks before is better than two weeks...and, indeed, there may some guidelines that support a specific stopping time.  But, in a larger sense, the effect of smoking, including second hand smoke, may last, to some degree, much longer than that.  It may be many years before the vessels in a smoker return to normal following the cessation of intake. 

It unfortunately has to be accepted that smokers will typically have an increased risk of wound healing problems when compared with non-smokers.  Exactly where, and when, and for how long, and to what degree, are hard to predict with any degree of scientific accuracy.

I hope that this helps, and good luck,
Dr. E

Smoking Before Surgery

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

Emily J. Kirby, MD
Fort Worth Plastic Surgeon

Smoking and tummy tuck

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

Risk of skin necrosis from smoking

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

3 months prior to tummy tuck, I ask my patients to stop smoking !

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

Necrosis in smokers after a Tummy Tuck

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

Smoking and surgery

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

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.