Quitting smoking before surgery: why 4 weeks?

When the pre-surgery instructions say “Please stop smoking for at least a month,” some people feel it’s too much. Wouldn’t a few days be enough? There is evidence behind that “month.”

First, how much smoking affects wounds. In 2012, a Danish researcher analyzed 140 studies covering more than 479,000 people. Compared with people who don’t smoke, people who smoke had about 3.6 times the risk of necrosis (tissue death) of the skin around the wound, about 2.1 times the risk of the wound healing slowly or opening up, and about 1.8 times the risk of surgical site infection. The nicotine and carbon monoxide in tobacco narrow blood vessels and reduce the oxygen reaching tissue. The cells that heal wounds end up short of the oxygen they need to do their work.

This matters even more in liposuction and fat transfer. With fat transfer in particular, the transferred fat has to survive on oxygen seeping in from the surrounding tissue until new blood vessels grow into it. An environment short of oxygen works directly against fat retention.

So does quitting help? When Canadian researchers pooled 6 randomized clinical trials in 2011, quitting smoking before surgery reduced postoperative complications by 41%. Each additional week of quitting increased the effect by 19%, and the effect was larger in trials where people quit for 4 weeks or more. A review of the changes in the body by the same Danish researcher found that after quitting, tissue oxygen and metabolism recover quickly, and the function of inflammatory cells partly recovers within 4 weeks. On the other hand, the process of making collagen, which fills in wounds, was affected for longer. Replacement products such as nicotine patches had little effect.

In short, quitting for even a few days has some value, but it takes about 4 weeks for the body to regain its readiness to heal wounds. And after surgery, you shouldn’t start smoking again while the wound and any transferred fat settle in. That’s also why I ask you to avoid alcohol and smoking for at least a month after breast fat transfer.

If you find it hard to quit, please tell me honestly before we set a surgery date. Pushing the date back a little may be the better choice for your result.