Smoking and Breast Reduction?

My Breast Reduction + Lipo is scheduled for next week, but i JUST quit smoking (its only 6 days away). Do i HAVE to reschedule?? I really cant afford TO reschedule and i already have 2 weeks off work for recovery. I am so ashamed that i did not have better willpower to quit sooner. Thank you for your time :)

Doctor Answers 16

Smoking and breast reduction

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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 breast reduction 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. Hope that this helps! Best wishes!

Smoking and Breast Reduction: a bad combination

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The decision is a joint one up to you and your surgeon. I would contact your plastic surgeon as soon as possible and let him know truthfully. He will appreciate your honesty. Next a discussion over your specific increased risks in necessary before a decision is made. 


Other factors need to be considered and  also add up such as being overweight, on Birth Control Pills or hormones, or if you have a medical condition that causes hypercoagulation. Most experts unanimously agree that smoking increases the rate of  breast  surgical complications significantly. Just about all plastic surgeons strongly recommend  women  to stop smoking and all nicotine products well in advance of breast augmentation with breast implants.  Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.A scientific article in the Archives of Internal Medicine indicated that, among all forms of surgery, quitting smoking eight weeks prior was never associated with an increased risk of complications.

Here is the reason why: the nicotine in cigarettes and other tobacco products (including Nicorette gum, patches, etc) is a vasoconstrictor, meaning it makes the Smoking is a significant multiplier of many potential complications following surgery and breast augmentation with implants are no exception. Nicotine from smoking causes blood vessels to vasoconstrict ( tighten up). Over time, these constricted arteries and capillaries deliver less blood to the breast tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as infection, and in particular capsular contracture (hardening and distortion of the implants). General complications of surgery such as blood clots, anesthetic problems such as pneumonia are also increased. For example,  for a tummy tuck there is increased likelihood of both an infection and loss of skin because of inadequate circulation

Smoking and surgery

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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.  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.
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

Breast Reduction

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To stop smoking is a difficulty but healthy accomplishment.  Smoking definately causes healing problems and some surgeries are more at risk than others.  Breast Reductions, Breast lifts, facelifts and tummy tucks are the most vulernable in my opinion.  I request patients to stop smoking for one month preop and one month postop.  Also it is important to refrain from nicotine gum or patches as these can put the same harmful substances into your bloodstream.  You must talk to your surgeon to be sure you are taking the safest route possible.  I hope this information is helpful.

Ronald H. Stefani Jr, MD
Chicago Plastic Surgeon

Best to come clean on smoking before breast reduction

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It is difficulat to say how long to away from smoking before breast reduction surgery, though smoking may increase your risk of a complication healing afterward. Best thing is letting your surgeon know so that you can be scheduled appropriately.

Smoking and breast reduction complications

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Thanks for your question, and good job quitting smoking, however you bring up an excellent point of debate, how long is long enough before major surgeries like a breast reduction to quit.  My advice has always been 3-4 weeks before and 3-4 weeks after to reduce smoking related healing complications.  Each surgeon uses different breast reduction techniques-some of which are more susceptible to the negative effects of nicotine.  Please call your surgeon to discuss this important matter.  Good luck.

Smoking and breast reduction

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Glad to hear that you were able to quit smoking but sorry to hear that it has only been one week.  I would recommend that you be honest with your plastic surgeon and speak with him/her regarding the smoking.  While it may be inconvenient to reschedule surgery, it will be much more inconvenient to experience any of the post-operative complications associated with the use of nicotine -- nipple necrosis, wound breakdown, fat necrosis, etc.  Any of these complications could further delay your return to work and full physical activity as well.  Again, please speak with your plastic surgeon and good luck!

Rescheduling Breast Reduction Due To Smoking

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It is better to endure the inconvenience of resheduling than to suffer a major or even a minor wound healing issue of your breast reduction. You will get over the former way before the latter. You need to discuss this with your plastic surgeon immediately.

Breast reduction and smoking

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This is a discussion which you needed to have had with your surgeon at the time the surgery was scheduled. All smoking is bad in terms of scarring and wound necrosis, but the more you have smoked, the greater the risk. I agree with others that you are assuming risk by having the surgery now---and that you need to be forthright with your surgeon and take responsibility for the cancellation.

Talk to your Plastic Surgeon

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What matters most at this point is you address this particular question with your plastic surgeon. Hoping that someone would say it will be fine, in this forum is not the right approach. 

Moneer Jaibaji, MD
San Diego Plastic Surgeon

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.