Smoking and Risk of Complications

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Smoking has been clearly shown to be a risk factor for cancer, coronary heart disease, pulmonary disease, peripheral vascular disease and other diseases. However, smoking has an impact not only on healthy people, but it also affects patients before and after every surgery. Many surgeons believe that smoking results in impaired wound healing and poor surgical results. Usually patients do not even realize the negative effect of smoking on surgery outcome. Smoking has especially negative effect on operations such as faceliftabdominoplastybreast reconstruction surgeries, free-tissue transfer and digital replantation.

Smoking and complications

Smoking tobacco appears to be a major enemy of surgical procedures, in addition to other known potential risk factors such as alcohol, unhealthy eating habits and other.  Plastic surgeons devote considerable attention on surgical techniques and treatments that promote normal wound healing in order to produce the best surgical outcome. Within a variety of different surgical scenarios smoking can dramatically influence wound healing and complicate it and cause a risk for skin necrosis or flap necrosis and increased postoperative pulmonary problems, and especially risk of surgical site infection.

Tobacco smoke contains more than 4,000 chemicals such as nicotine and carbon monoxide. All these chemicals due to its impact lead to complications. These chemicals induce endothelial injury, decrease capillary flow, and stimulate catecholamine. As a result, it leads to thrombogenesis, decreased oxygen delivery, microvascular injury, impaired wound healing and leukocyte, macrophage, fibroblast and platelet dysfunction which may cause an infection.

Smoking is also a risk factor of cardiovascular problems such as blood pressure, heart rate, and the systemic vascular resistance and pulmonary diseases which can cause a lot of complications and even a death during or after surgery. Also it is know that during the post operative period, smoking patients need more oxygen and more analgesic than non-smokers.

Medical research

Medical research conducted around the world enhances a premise that smoking results in poor surgical results.  According to the studies carried out,  non-smokers in comparison with  smoking patients have significantly higher risk associated of wound infection after all types of plastic surgery. They tend to heal slower and there is a risk of complications after surgery. It is similarly applicable for both light and heavy smoking patients. They are easily swayed for skin flap necrosis and for connective tissue diseases. No significant dose-response of tobacco relation was disclosed.

Another research was made comparing patients-smokers after face-lift operations and it was found that smokers have a 13-fold risk of skin necrosis. In breast reduction operations the risk among smokers is doubled for number of complications such as necrosis and infection. Some scientist suggest that smoking should be a relative contraindication for surgery such as breast reconstruction, especially transverse rectus abdominis myocutaneous flap surgery because these smoking patients are at especially high risk for perioperative complications – flap necrosis and hernia. Also some smoking related problems were found in research of patients who had undergone abdominoplasty. Wound healing problems were registered. The rate of wound problems and wound spontaneous opening showed a statistical difference between smokers and nonsmokers.


In some cases there is no difference whether a patient is active or passive smoker. Passive smoking can also result in nicotine levels in the blood and tissues and lead to surgery complications. Smoking is a strong addiction and it may be really hard to get out of this habit. However, patients who are planning any plastic or cosmetic surgery, as well as gastric bypass surgery or any other, should stop smoking about one month prior to surgery until wound healing is completed.