Smoking and the Breast Reduction Patient

Breast reduction surgery, irrespective of technique, is very dependent on circulation for proper healing of deeper tissue, overlying skin, and the nipple and areola. Nicotine constricts blood vessels and therefore decreases oxygen delivery to healing tissues. Carbon Monoxide in smoke displaces oxygen so that it is not optimally delivered to tissues. Tissue loss can occur from the decreased blood supply.

With respect to plastic surgery, and breast reduction surgery in particular, we effect changes in the skin and deeper structures (fat, breast tissue) by tightening, elevating, and reshaping it. During these maneuvers, the skin and underlying tissues experience a temporary and expected, slight decrease in blood supply. Healthy, non-smoking individuals tolerate these temporary disturbances much better than smokers. If you smoke, there is a real risk that your tissues and skin will not tolerate the movement. This translates into poor circulation to healing skin edges, skin or tissue loss, fat necrosis (scarring and tissue loss deep in the breast), open wounds, infections, and poor scarring. In almost all cases the results will not be as good as with a non-smoker.

In patients who smoke, we most commonly see delayed healing from poor circulation to skin edges. This requires daily wound care until complete healing is achieved. Wounds in this situation can take months to heal, and can lead to wide or depressed scarring. Patients who smoke are advised to abstain from smoking 6 weeks before surgery and 6 weeks after surgery. It’s a perfect time to quit smoking altogether. Quitting smoking will not prevent minor complications, but may decrease risks for their occurrence.

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