pack a day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

Doctor Answers 11

Smoker for 20 years. How long to quit before surgery?

Smoking brings a significant risk of cancer, stroke, heat attack, etc. From a Plastic Surgery standpoint it is a vasoconstrictor. Wound healing is all about getting oxygen and needed entities to the wound. It is well known that patient who smoke have a tremendous increase in their rate of serious complications, (infections, wounds falling apart, etc.). Nicotine is the main vasoconstrictor, so getting a patch of nicotine won't help the vasoconstriction. Best to be off the tobacco/nicotine entirely before surgery. Please be honest with your Board Certified Plastic Surgeon. Together you can make a plan to quit and proceed with surgery. The amount of time between quitting and surgery will depend on the Plastic Surgeon and the procedure

Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Smoking and surgery

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

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Pack per day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

Hello! Thank you for your question! The issue with nicotine is that it also acts as a vasoconstrictor, clamping down of blood vessels. Blood supply is always of great concern during any surgical procedure, but especially in such a procedure as a mommy makeover where the viability of the skin/tissue, belly button, and nipple-areolar complex is obviously important. Since the vascularity to the area is already tenuous since it will be raised by cutting around the area, maximizing blood flow to the tissue is critical.

Typically, we recommend at least 6 weeks of smoking cessation prior to and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, nipple necrosis, poor scarring, and wound complications, as well as other health consequences including blood clots. The anesthesia risk is greater with general anesthesia as well as pulmonary issues/lung infections postoperatively. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Pack a day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

You will need to be tobacco free for at least a month prior to surgery.

Find a board certified plastic surgeon who performs hundreds of mommy makeovers each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Smoking and surgery

I would advise being off ALL forms of nicotine (gums, patches, lozenges) at least 4-6 weeks before AND after surgery.  The effects of nicotine on wound healing are significant!  For the best results and least risk of complications, PLEASE discontinue nicotine asap.

Janet Turkle, MD
Indianapolis Plastic Surgeon
4.8 out of 5 stars 61 reviews

Pack a day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

I generally recommend quitting as soon as possible, but tell all my patients that I want them off at least 6 weeks prior to surgery.  There are too many benefits to quitting tobacco products to list here, but the bottom line is that the surgery will be safer for you and your recovery should be better as well.

For more information, please go to my website at:

Garrett A. Wirth, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 11 reviews

Pack a day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

The sooner you quit before surgery the better.  Smokers have a higher risk of complications.  Smoking potentially puts you at a higher risk for general anesthesia as well as necrosis (or death) of tissue (skin).  Since blood flow is decreased healing can take longer as well as wound complications are increased.  I have all of my patients stop smoking for 1 month before surgery and following surgery.

Frank Lista, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 111 reviews

Smoking and elective surgery

There are several studies that clearly show that smoking increases the risk of cosmetic surgery, especially abdominoplasty, facelift, and breast lift procedures. There is no consensus on the exact amount of time before surgery that you should cease smoking to minimize your risks. But most surgeons would want you to stop at least 4-6 weeks before your surgery and then continue to be smoke-free for an additional 2-4 weeks after surgery. My suggestion is that if you can quit, then quit today. The sooner the better. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 84 reviews

Quit at least 4 weeks, preop.

Not only will the tar and nicotine potentially cause necrosis (death) of the tissue flaps (TT, Breast lift, etc.), it can potentially make you a higher risk for general anesthesia as well as the post-op course.  Many long term smokers start to decrease the number of cigs/day but then experience worsening cough and mucus expectoration, due to less suppression of the tracheal (windpipe) mucus cells.  Often this phenomenon discourages the would-be quitter who resumes the usual number of cigarettes and the cough resolves.  Quitting a month ahead of your scheduled surgery will allow your respiratory tract to "recover" sufficiently so your risk of post-op complications, such as delayed wound healing and recurrent abdominal weakness.  Quit long enough and you'll save money as well as potentially reduce your risk of cardiopulmonary events (heart attacks, strokes, etc.) as you age.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Pack a day smoker for 20 years, plan on mommy makeover in the spring. How long is recommended to quit smoking before surgery?

The sooner you stop the use of all forms of nicotine, the better.  For the best chance of success, stop now.  In my practice, I ask patients to be nicotine free for at least 4 weeks prior to the procedure. Nicotine is a powerful constrictor of blood vessels,  decreasing blood flow to the “flaps” used during these procedures. This decrease blood flow could potentially lead to wound healing problems and/or tissue necrosis.  Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

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.