I always ask my patients if they smoke, and how much.

For the best outcome from surgery, I strongly advise that patients who smoke cease their habit for at least two weeks prior to and two weeks after surgery – or at least significantly reduce the amount they smoke. The ingredients in cigarette smoke constricts blood vessels and reduces the ability of wounds to heal. Although I do not enforce smoking cessation as a mandatory condition for surgery to proceed, especially if surgery is more urgently necessary such as in the case of cancer or trauma related conditions, I do advise patients that they are at a much higher risk of having an adverse outcome if they continue to smoke.

Let me give you three clinical scenarios.

Skin grafts. When a skin graft procedure is performed to cover an open wound, it begins life as a clinically “dead” piece of skin. It needs to be “resuscitated” back to life (and rather quickly!) through the blood and nutrients derived from the area upon which it has been placed. After a few days of struggle, the skin graft establishes it’s own circulation. Such is the wonder of human healing. In smokers, the blood vessels are narrowed and blood flow is sluggish. Skin grafts in such circumstances can struggle to pick up sufficient blood and nutrients to keep it alive.

Breast reductions and lifts. As part of a breast reduction or lift procedure, the nipple is frequently elevated to a higher, more normal, position on the breast. The nipple is kept viable by maintaining and protecting tissues that connect the nipple to its blood supply. Although nipple loss – partial or complete – is a possible risk to all patients undertaking breast procedures, smokers are at a much higher risk, based on the same reasoning of compromised blood supply. To hit home the point, I sometimes exclaim to patients that their nipples could “die and fall off”! This is of course a rather uncommon but devastating worst case scenario.

General wound healing. Not too long ago, I performed surgery on a patient who sustained a traumatic injury to his hand. The wound was thoroughly cleaned and repaired. Instructions were given for the patient to stop (or at least greatly reduce) smoking. Under such circumstances, and with the appropriate wound care and infection control measures, I would expect the wound to heal up without any problems. When the patient turned up for his follow up review, he smelled like an ashtray. So much so that I had told him that I was endangering my own life by passive smoking through his breath! Not surprisingly, his wound remained unhealed for many weeks, as if someone had pushed the pause button on his body’s healing remote control.

Smoking is highly addictive. I know that. And I appreciate how hard it is for patents to stop smoking, especially in a short given time. I state the facts though, of what can likely happen if they continue to smoke during their period of surgery. Wounds can be slow to heal and can more easily develop an infection. Abdominoplasty closures can break apart and take months to heal with an big gaping wound. Facelift cheek skin can turn black and slough off. Skin grafts can die, dry up, and shrivel away. Nipples can fall off.

On a brighter note, many of my patients who stopped smoking prior to their elective surgery have continued to stay off the cigarette. Perhaps their surgery and determination to get a good result gave them a strong enough reason to quit the habit. Perhaps, together with their post surgical state of higher confidence and self esteem, they are also hoping to give away negative habits. Or perhaps the health hazards of smoking has finally hit home. Whatever the reason, they are leading a healthier life, and saving money to boot!