Is not performing surgery on a smoker a form of discrimination? I am well aware of the risks and complications.

Question

While it is ideal to stop smoking prior to a procedure, I find it discriminating to refuse surgery to an active smoker. My friend, (an alcoholic) went through surgery without a question. A Colleague, (pot smoker), not a problem. Me, who wants a breast reduction, has been turned away from Ontario surgeons. I'm in pain, and find my relief (albeit sad), in smoking instead of popping pills... Perhaps if I felt better and wasn't in constant back pain, I'd be more encouraged to quit....

Joshua Cooper, MD, FACS · Answer

I do not perform breast reductions, breast lifts, or tummy tucks on any patient who smokes cigarettes.  The nicotine, along with the incisions that are made during these operations, impairs the blood supply to the skin and/or nipple and areola. This means the nipple/areola can die and wound healing issues are increased.I do operate on patients that smoke marijuana because I have not found this to cause death of skin and/or nippples/areolas. Additionally, I have never had a patient who drinks alcohol end up with skin that dies. I have had many patients who have successfully quit smoking in order to undergo plastic surgery. And they never begin smoking again!Take this opportunity now to quit smoking in order to improve your quality of life!Best of luck to you, and thanks for sharing!

Urmen Desai, MD, MPH, FACS · Answer

Smoking as its own risks with surgery and surgical outcome.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Ronald J. Edelson, MD · Answer

Legally and ethically any doctor can refuse to enter into a doctor patient relationship with anyone.  In your case, it sounds like the surgeons you have seen feel the risks from smoking outweigh the benefit of your operation.  This is entirely ethical and legal.  You don’t want a surgeon operating on you if they don’t think it’s wise, do you?

Jeffrey A. Sweat, MD · Answer

No, this isn't discrimination.  As doctors it is our responsibility to make sure that you are as healthy as possible prior to surgery and as surgeons, it is always our responsibility to make sure we minimize any possibility of postoperative complications, which can be emotionally and financially exhausting.  While you mention that your friends have had surgery with their own health issues, you didn't mention whether those surgeries were elective (did not HAVE to be done) or whether they were urgent or emergent and had to be done for a patient to survive regardless of overall health status.  To put it a different way, your breast reduction could definitely improve your quality of life but doesn't have to be done to save your life.  Surgeons routinely deny surgery to patients whose less than ideal health status makes for more risk than the surgery might benefit.  You do have control over whether or not you smoke, even if it might be a challenge for you, so it is not unreasonable for your surgeon to ask you to quit smoking so that you do everything possible on your side to ensure a good outcome just as you expect the surgeon to do everything possible on their side to ensure your good outcome.  I make this analogy to any patient that I ask to quit smoking prior to an elective surgery: you would not want me to have a glass of wine or cocktail prior to your surgery (nor would I ever do so) because you want me to be at my best prior to your surgery.  We're simply asking that you be at your best as well and do your part to minimize the risk of surgery, just as we will do all that we can, so that we are truly partners in this endeavor.  I hope this makes sense and encourages you to quit smoking prior to your surgery and hopefully for good.  While you may eventually find someone who will do your surgery even if you smoke, the best doctors are going to make you quit smoking first because they truly care about you as a person and want your best possible outcome.  Best of luck!

Daniel Barrett, MD · Answer

Dear  Needs a Reduction,smoking interferes with wound healing and can cause severe complications. Most plastic surgeons recommend smoking cessation before and after the surgery. But every plastic surgeon has his own postoperative 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

Farbod Esmailian, MD · Answer

Breast reduction surgery is already a procedure that can have some issues with healing just given the nature of the procedure.  My patients who smoke prior to a breast augmentation are encouraged to stop and the risks of increased capsular contracture are discussed as well but I leave it up to them to decide. The issues with doing surgery while the patient is smoking differs from one procedure to another given the nature of the procedure.  Breast reduction, breast lift, tummy tuck...those procedures are very high risk for disastrous complications if the patient continues to smoke prior and/or after the surgery.  Most surgeons will want the patient to be smoke free 4 weeks before and 4 weeks after surgery.Smoking decreases the oxygen delivery and blood flood to the area and can cause skin necrosis and nipple and areola loss.  It is a complication you and your surgeon do not want to have.  You can google images of "smoking and breast reduction".Hope that helps.

Curtis Wong, MD · Answer

as you would not be refused if this was an emergency.  But breast reduction is not an emergency.  The ability to cease smoking shows surgeons the willingness of the patient to do everything possible to get the best outcome.  Refusing to stop smoking tells surgeons you 'don't care' so how can you expect a surgeon to care when you don't?  There are many services and pharmaceuticals out there that you can use to help stop smoking. There also hypnosis that has been successful and you cn find them by googling 'how to stop smoking'.  But if you're not willing to create the best environment to avoid catastrophic complications, why should a surgeon do an elective procedure on you???

Jon Kurkjian, MD · Answer

No it is not a form of discrimination. First and foremost, as doctors, our responsibilty is to do no harm and by operating on you while smoking, is only setting you up for failure. Nicotine use, not just smoking, but also vaping, gum and chewing tobacco decrease the body's ability to heal appropriately. If you find a surgeon who will operate on you while smoking, be prepared to learn how to do wound care.  Please do your research and consult with a board certified plastic surgeon.

Charles T. Slack, MD · Answer

No it is not discrimination. A doctor is not obligated to operate on you just because you have symptoms that a particular surgery might help. Surgeons should assess the risk for each patient. If they feel like the risk of complications in a particular patient are high and the consequences of those complications are potentially severe, they should tell you that you are not a good candidate and explain why. You may still feel the surgery is worth the risk to you but that does not mean that it is worth the risk to the surgeon. Some surgeons are more conservative then others so you may still find one that is willing do it; however, I would be skeptical of one who would agree to do it while you are somoking. That is just asking for trouble. By trouble I mean significant nipple necrosis or skin necrosis which may be impossible to recover from aesthetically. Breast reduction is a fantastic operation that really helps my patients. Quitting smoking is hard but is doable. I've seen many patients do it. If the surgery is that important to you look into ways that may help you quit smoking. There are a lot of positive things from a health standpoint including being a safer candidate for plastic surgery.

Scott C. Lindsay, DO · Answer

Thanks for your question!  It is not discrimination.  Alcohol, while is not the safest if misused, just needs to be stopped 72 hours prior.  I would have made a marijuana user quit that also prior to surgery.  Your surgeon is trying to do what is in YOUR best interest.  A breast reduction should be a positive experience and worst case scenario if you don't quit smoking, you could experience necrosis and lose one or both of your areolas.  Good luck.

Is not performing surgery on a smoker a form of discrimination? I am well aware of the risks and complications.

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