Being asked to stop smoking before surgery is one of the instructions patients resist most. Yet it is not general health advice; it is a technical requirement that directly determines the outcome.
Nicotine narrows blood vessels
Nicotine narrows small blood vessels and reduces blood flow to the tissues. Carbon monoxide lowers the amount of oxygen the blood carries. The skin lifted during surgery already relies on a limited vascular network. When that network is further narrowed by nicotine, the chance that part of the skin will lose its supply and be lost increases significantly.
The operations at highest risk
- Tummy tuck, the highest-risk group, because a large area of skin is lifted
- Facelift, compromised blood supply to the skin around the ears and poorer scar quality
- Breast lift and reduction, wound breakdown, particularly at the T junction
- All operations involving nipple repositioning and free tissue transfer
For how long?
You are asked to stop at least 3 weeks before surgery and not to start again until at least 3 weeks after. Four weeks is better still. That is the time the vascular response needs to return to normal.
Two common questions
Are e-cigarettes or nicotine patches acceptable? No. The substance causing the problem is nicotine itself; the route it takes does not change its effect.
I smoke very little; does that matter? Even a few cigarettes a day change the vascular response. What matters is not the quantity but whether nicotine is in the circulation.
For a patient who says they cannot stop, I may prefer not to perform certain operations. That is not a judgement but a decision to avoid a predictable complication.
