I do not smoke cigarettes but I do smoke marijuana. Could this have caused the dead tissue under my nipple?

Hello,Thank you for your question, and attached images.The problem with smoking and wound healing is profound.  When inhaling the products created from the combustion of either tobacco, or other, you are taking in carcinogenic chemicals, and carbon monoxide to name a few.The carbon monoxide attaches to the red blood cells permanently, and does not allow oxygen delivery by that red blood cell to the tissue.  The tissue that is healing from surgery is highly metabolic and needs profuse oxygenation; more than uninjured tissue.  Additionally, the nicotine absorbed if tobacco is used, causes vasoconstriction of the blood vessels- this also limits oxygen delivery by the restricted blood flow to the tissue.I hope this helps.Thank you,S.P. Maggi, MD, FACSdrmaggi.comAustin Plastic Surgery Center 

Hello! Thank you for your question! The issue with nicotine or any inhalant 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 mastopexy where the viability of the
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. Tissue/skin necrosis as well as ingfections are risks for any breast reduction procedure.  Hope that this
helps! Best wishes!

When you undergo a breast lift, there is always risk of tissue loss whether you smoke or not.  You need to allow the wound to heal and see what things look like. You may need a revision in the future bit should provably wait about six months.

Marijuana cigarettes are bad for healing, particularly with facial, abdominal or breast surgery.  I've seen the effects firsthand.  I'm not sure how ingestible cannabis would affect healing but I would not take the chance.  By its nature, plastic surgery takes tissues to the edge of their biologic capabilities.  Some things, such as smoking (including cannabis) can push the tissues over the edge and patients can get tissue necrosis, poor scarring, etc.

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. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion.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.Best wishes,Pablo Prichard, MD

It may have contributed to tipping the balance in the healing process but it does sound like it will heal quickly and a small procedure to tidy the scar under local in a few months may sort things out. Don't be too hard on yourself. Best wishes

Any material that is burned creates products of combustion that are harmful to the lungs and circulation.  When smoke is created there is carbon monoxide and this is toxic to your red blood cells.  Your blood will not be able to carry and deliver as much life sustaining oxygen to the tissues.  Any product you smoke will be harmful to healing of tssues.

Its hard to say what caused that but it does happen from time to time.  This is because the blood supply to the skin flap is delicate.  Things like nicotine can reduce the blood supply.  Systemic disease like diabtetes can also cause this problem. The good new is that it usually heals pretty quickly.  You may need a scar revision down the road.  Good luck!

Bottom line smoking anything just before or after cosmetic surgery is not a good idea and while one cannot prove that smoking pot was responsible for your complication it certainly did not help!Dr Corbin

Thank you for your question.Yes, any type of smoking can cause tissue death.Multiple studies have shown that the by products of smoking (doesn't matter what type)cause vasospasm (the shut down of blood to tissue) especially in the postoperative period. Thus blood, antibiotics, oxygen, nutrients  and healing factors can't get to the tissue edges and a consequence is tissue loss and poor scar production. Smoking post operatively has  been shown to be much worse than preoperatively. This even pertains to second hand smoke.Everybody  tissue is more or less susceptible to the affects of smoking. Regrettably, once you have had this problem you are much more susceptible happening again.I suggest that stop ALL types of smoking NOW (preferably for ever) but a least until all your wounds are are completely healed.I suggest you talk with your surgeon directly about all of this.Best wishes for a hopefully uneventful recovery.