Can I Have Breast Reconstruction If I Am Or Was a Smoker?

— -- Question: Can I have breast reconstruction if I am, or was a cigarette smoker?

Answer: Breast reconstruction in people who smoke cigarettes is very difficult and makes the surgery potentially much more ominous; it can have much more morbidity. Now if you've smoked in the past, and you've quit for at least several weeks, your risk goes much further down. And if certainly if you smoked years ago, that's okay. But for people who actively smoke when seeking breast reconstruction, there are several problems. If we're going to transfer tissue from one part of the body to the next -- in either the tram flap, which is the one from the abdomen, or the latissimus flap from the back, or a free flap, where we sew the blood vessels together under the microscope -- the potential problems or complications with smokers goes way up; it probably goes up between 40 and 60 percent.

And it's for varied reasons. It's not only the tar and nicotine in cigarettes, but other agents in cigarettes cause blood vessels to constrict -- that means the blood vessels can get really small. And so the tissue that you're transferring doesn't get enough blood supply, and it becomes what we call 'ischemic,' which means the tissue doesn't get enough blood supply and dies. And so you have a big, black piece of the flap on your breast reconstruction.

And this pertains to any field of plastic surgery; if we do a facelift and somebody is a heavy smoker, or a smoker at all, they have a much higher risk of part of their facelift not healing correctly. And so for someone who wants breast reconstruction, the one thing we very much ask is, at least for that period of time while you're about to undergo your surgery and while you're recovering from your surgery, try to stop smoking. And that means also nicotine patches and things like that, because the nicotine itself can cause some of the blood vessels to constrict.

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