Smoking Risks and Breast Reconstruction

Nothing strikes fear into the heart of a woman more than getting a diagnosis of breast cancer. From the time those two words are spoken, her life and all those she holds dear to her change dramatically. There are many difficult choices and decisions to be made in a very short time. Not only are the options of radiation therapy and chemotherapy discussed, but she also faces surgery to remove either the lump or the breast, and then breast reconstruction.

Surgery Complications Caused by Smoking

With any surgery, there are always risks and complications. Infection is a major concern, but with breast reconstruction there are some serious risks for those women who are smokers. During breast reconstruction, either an implant is placed, or a TRAM (transverse rectus abdominis musculocutaneous) flap is performed, which can become compromised due to the complications caused by smoking.

During any surgery, the blood and oxygen supply in the tissues is diminished at the site of the incision and trauma. In those who smoke, nicotine and carbon monoxide cause the blood vessels to constrict, further reducing the ability of the body to heal naturally. Also, the risks of anesthesia are much greater in smokers and can lead to heart attack, stroke, pneumonia and even death. Therefore, women who smoke are at increased risk of developing problems after the procedure.

In the journal Plastic and Reconstructive Surgery, the author states that almost 40% of the women undergoing breast reconstruction had complications. These include flap necrosis, fat necrosis, seroma, opening of the wound, blood clots, and infection. On top of these problems, there is also much pain and discomfort associated with them, and the likelihood of more surgical intervention.

Issues after Surgery
Because of these issues, the overall appearance and feel of the reconstructed breast can be negatively impacted. Scarring can be even more severe and disfiguring in smokers, leading to more fear and depression over the woman’s appearance. Losing part or all of a breast can feel, for a woman, like losing a part of herself. The reconstruction surgery may seem like a godsend, a huge prayer answered, but then those feelings return when it fails. The pain and suffering can be intense.

A Healthy Solution
There is good news, however. Studies have shown that smoking cessation, of as little as three weeks prior to the reconstruction surgery, can level the risks to that of a nonsmoker. This can be a daunting option, though, since she is facing such a life-changing event that has tremendous fear associated with it.

Smoking cessation under other circumstances is a huge undertaking and is stressful in itself. While some surgeons will not operate on a smoker, there are steps that can be taken to alleviate this problem. There are smoking cessation products that can be used, but the ones containing nicotine have to be avoided. Some physicians will test for nicotine prior to surgery. There are also prescription medications to help that have no nicotine.

On our website,, you can learn more information about breast reconstruction and the risks and benefits.

(Contributed by Ron)

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