Smoking and Surgery: A Risk to Healing and Aesthetic Outcomes
One of the most crucial factors in post-surgical recovery is ensuring adequate blood supply.
This is particularly important in breast surgeries (top surgery, breast reduction, gynecomastia) and abdominoplasty (tummy tuck), where compromised blood flow can lead to severe complications.
Smoking, in particular, constricts blood vessels and reduces oxygen supply to tissues, delaying recovery and increasing the risk of complications.
1. Risks of Smoking in Breast Surgery
Blood Supply to the Nipple and Areola
In breast surgeries, the nipple and areola are highly dependent on adequate blood flow.
When nipple repositioning or grafting is performed, the pre-existing vascular connections to the breast tissue are severed, meaning the new blood supply must rely on microvascular regeneration.
- Smoking-induced vasoconstriction significantly reduces blood flow, increasing the risk of necrosis (tissue death) in the nipple and areola.
- Poor blood supply may lead to discoloration, turning the nipple a dark purplish or black shade, indicative of impending necrosis (Kroll et al., 1992).
- Uneven blood flow may result in asymmetry or irregularly shaped nipples, rather than a natural circular form.
- Smoking exacerbates hypertrophic scarring, causing thickened, raised scars that can impact aesthetic outcomes (Lipshy et al., 2019).
2. Risks of Smoking in Tummy Tuck Surgery
Blood Supply and Navel Repositioning
During abdominoplasty, extensive tissue dissection occurs, and the navel is repositioned.
This process can temporarily compromise blood supply, making it susceptible to smoking-related complications.
- Insufficient blood supply can cause discoloration (darkening or purpling of the navel) and necrosis (Rohrich et al., 2003).
- Vasoconstriction from smoking increases the risk of irregular navel shape due to uneven tissue healing.
- Delayed wound healing and increased risk of seroma formation (fluid accumulation) occur due to inadequate blood flow (Hunstad & Repta, 2009).
- Hypertrophic scarring is more likely, leading to thickened, less aesthetically pleasing scars.
3. Pre- and Post-Surgical Smoking Guidelines
For smokers undergoing surgery, the following guidelines should be strictly followed:
- Cessation of smoking at least one week before surgery and for at least two weeks postoperatively is recommended to reduce complications.
- Nicotine patches and e-cigarettes should also be avoided, as nicotine still causes vasoconstriction (Feldman et al., 2017).
- If quitting is challenging, consulting a physician for nicotine replacement therapy (NRT) alternatives may be beneficial.
Smoking is not just a general health risk but a direct threat to surgical success and aesthetic outcomes. Ensuring optimal blood supply is vital in preventing complications and achieving the best surgical results.
For those considering surgery, modifying smoking habits is an essential first step toward safer procedures and improved recovery.