57, former smoker of 40 years - is it safe to have a breast lift?

Question

I am 57 quit smoking 1 1/2 years ago have type 2 diabetes that is controlled but surgeon won’t do the breast lift with removing breast implants because he said I smoked for 40 years.

Mert Demirel, MD · Answer

Quitting smoking 1.5 years ago is a very positive factor. The highest surgical risk is with active nicotine use, because nicotine reduces blood flow and increases the risk of wound healing problems, skin loss, nipple complications, and infection.
A 40-year smoking history can still matter because it may affect blood vessels, lung function, and overall healing capacity. However, it does not automatically mean a breast lift is impossible. The decision should be based on your current health, circulation, diabetes control, medications, exam findings, and the complexity of the surgery.
Controlled type 2 diabetes is also important. Many surgeons will want a recent HbA1c, good nutrition, no nicotine exposure at all, and medical clearance before considering implant removal with lift. If the A1c is high or circulation is poor, delaying surgery may be safer.
Your surgeon may be conservative because implant removal plus lift can place stress on the breast skin and nipple blood supply. In a former smoker with diabetes, that risk needs to be taken seriously.
My advice would be to ask what specific risk factor makes them decline surgery: smoking history alone, diabetes numbers, circulation, or breast anatomy. A second opinion from a board-certified plastic surgeon is reasonable, but be honest about your full smoking history. If you remain nicotine-free and your diabetes is well controlled, surgery may still be possible with careful planning.

Serdar Bora Bayraktaroglu, MD · Answer

Your surgeon’s hesitation is rooted in strict safety protocols. Even though you successfully quit smoking 1.5 years ago, a 40-year history causes permanent, long-term microvascular damage that impairs small blood vessels. A breast lift requires precise blood flow to heal delicate tissue and reposition the nipple, while controlled diabetes also affects healing potential. Combined, these factors significantly raise the risk of tissue necrosis or complications. Surgeons prioritize your safety over immediate results, so establishing a stable health baseline and consulting your doctor about specialized nicotine testing or clearance may help pave the way forward.

Gary M. Horndeski, MD · Answer

If you have not smoked for 1 1/2 years then the nicotine should be cleared by this time. If you are cleared medically then you are a candidate for surgery. The technique I recommend called explantation with breast lift using the Bellesoma. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided and nipple sensation (in 95%) is maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Joel Patrick Maier, MD · Answer

If you have stopped smoking and do not use any nicotine products, I would not hesitate to proceed as this procedure will make you very happy. Wound healing is always possible in plastic surgery, and active nicotine increases the chance by 40%. As long as you have stopped at least 6week prior, you will minimise healing issues. Thank you, I hope this helps!

Semih Yildiz, MD, FEBOPRAS · Answer

Your concern is understandable. Having stopped smoking 1.5 years ago is a major positive, but a long smoking history and diabetes can still make a breast lift/explant higher risk because the nipple-areola skin and incision lines depend on reliable blood supply.
I would usually look at your A1c, overall vascular health, medications, BMI, breast size/ptosis, and whether a nicotine/cotinine test is negative. If a surgeon feels the lift is too risky, that is a safety judgment rather than a dismissal. A second in-person opinion can clarify whether a staged or more conservative plan is reasonable.

Daniel Barrett, MD · Answer

Dear Margiestamm,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

Might be safe. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved.  Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Ronald J. Edelson, MD · Answer

To me the main issue would be whether your breast tissue is thick enough to ensure circulation the the nipple.  If you had nit had the prior implant I would nit be as concerned. It also depends on far the nipple needs to be moved

Jeffrey M. Darrow, MD · Answer

A breast lift should be possible, even with your smoking history.  The main concern is the blood supply to the skin flaps created at the time of surgery.  If the extent of the elevation of the skin flaps is minimized, a lift can still be accomplished and the blood supply to the skin flaps stays more robust.  Whether minimal flap elevation could give the degree of lift you desire, would depend on your individual anatomy.  Speak with your Plastic surgeon about this. Best wishes.

Manuel Diaz, MD · Answer

Hello. In your case, before determining whether the surgery can be performed safely, I would first recommend both a pulmonology evaluation and an endocrinology evaluation.The pulmonologist would need to assess your lung function and respiratory status considering your smoking history, and the endocrinologist would need to confirm that your diabetes is properly controlled for surgery. Both specialists would need to medically clear and authorize the procedure before moving forward.It is very positive that you stopped smoking a year and a half ago and that your diabetes is controlled, as these are very important factors for healing and surgical safety Once you are properly evaluated and medically cleared, we can better determine whether you are a candidate for implant removal and a breast lift.

57, former smoker of 40 years - is it safe to have a breast lift?

Answers (11)

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