It is common for patients who are smokers to seek cosmetic plastic surgery procedures. The question is, does smoking prevent a patient from having surgery? The quick answer is ‘Not really!’
As a doctor, I’m supposed to tell you that smoking is a bad thing…and it is. Smoking causes changes that affect surgical patients in multiple ways. First of all, smoking will affect your anesthesia. It is common for smokers to cough more in the early post-operative period. Coughing raises blood pressure, which could increase the chances of early post-op bleeding. It also hurts more when you just had breast surgery! Smoking also affects the blood vessels in your body and is the greatest risk factor for peripheral vascular disease as you get older…also a bad thing.
As plastic surgeons, we often operate on things that have redundant blood supplies. For example, the skin of the lower belly gets its blood supply from two different sources; one from the muscles underneath, and the other from vessels that start from your ribs and travel from your side toward the center of your belly. Much of a tummy-tuck involves separating the skin from the muscles underneath, so the skin becomes even more dependent on those vessels from the side. These vessels are quite small and may be affected by smoking so much that there could be skin loss from the tummy-tuck.
During breast surgery, a similar scenario exists with the blood supply to the nipple/areola. The nipple and areola are the only part of the skin that covers your breast that is actually part of your breast tissue. All the other skin on your breast is merely chest skin. The nipple-areola complex receives its blood supply from two different places. One blood supply is through the breast beneath. The other is from the skin of the chest. Breast Lift surgery frequently involves a circular incision made around the areola that divides many of these blood vessels from the adjacent skin. This means that the nipple becomes more dependent on the vessels from below. Smoking affects this blood supply. The concern is that, with the effects of smoking, the surgery can cause enough of a change to jeopardize the health of the nipple.
As surgery becomes more aggressive, these risks go up. Lifting the breast more or making the skin really tight…these both can affect the blood supply even more. There are other parts of breast lift surgery that also affect this blood supply as do issues that occur after surgery, such as swelling and bruising. All of this effects blood supply… in fact, much of Plastic Surgery uses the study of the blood supply to tissues as a guide to the way we design our procedures for almost anything.
The crux of the issue is not crossing a line where the risks increase so much that the procedure becomes dangerous. Smoking itself moves that ‘line’. As long as we the surgeons understand this and adjust our procedures accordingly, many procedures can be done safely on smokers.
If you are a smoker, then your Plastic Surgeon should make this a main part of your discussion before surgery. If he does not, then he’s likely the wrong surgeon for you! Feel free to call Dr. Newman to discuss this further if you have any questions about Plastic Surgery procedures if you are a smoker.