In this day and age, if you’re a smoker, you already know that it’s bad for your health, but you might not know that your smoking can have a negative effect on any surgical procedure you might be having. From the beginning of your procedure and all throughout your recovery process, smoking increases your risks for complications.

Effects of Smoking

Smoking tobacco in cigarettes, cigars, or pipes has known effects on your respiratory system and other systems in your body. Using e-cigarettes, or “vaping” has also been shown to affect your body systems due to the nicotine content in the vapors. The smoke itself, as well as the nicotine being absorbed affect your body, can be harmful.

Respiratory Effects

Your respiratory system is lined on the inside with cilia, which are like tiny little wavy fingers. These cilia help keep your airways clear of dust, dirt, and mucus, so those things don’t end up trapped in your lungs. When you smoke, your cilia are lost, so your respiratory system is smooth and you’re less able to expel any foreign materials that might irritate your airways.¹

Smoking also increases the production of mucus.² Mucus is a necessary, but slimy, component of your body. It helps to warm the air you breathe, keeps cilia moist, and helps to trap bacteria and dirt you may breathe in. But, when you smoke, you produce more mucus, which can irritate the lining of your respiratory system since your protective cilia have been lost.

The combination of excessive mucus and a loss of cilia can lead to a chronic cough, since the lining of your respiratory system has been altered and is constantly being irritated by mucus, smoke, and your regular breathing. You could develop chronic obstructive pulmonary disease (COPD) because of the mucus buildup. The changes in your airway lining can also eventually cause cancer.³

Other Effects

Smoking also affects your blood. Your blood is the delivery system for everything your body needs to survive – oxygen, minerals, and other nutrients are carried from your head to your toes by your blood. Unfortunately, if you’re a smoker, your blood generally has more carbon dioxide than oxygen, which means that your blood isn’t carrying nutrients to the rest of your body as efficiently as it should.

The nicotine in cigarettes is also a vasoconstrictor.⁴ That means that nicotine narrows your blood vessels. That causes your blood pressure to increase, and can increase the risk of you forming clots in your vessels.⁵

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How does this affect my surgery?

Smoking can affect the way your body handles being put under general anesthesia, and will also impact your recovery from the surgery.

Anesthesia

Because of the way smoking affects your respiratory system, it can make your anesthesia provider’s job more difficult. Smokers tend to have hyperreactive airways, which means when they can be easily irritated by inhaled substances.⁶ General anesthesia involves inhaling aerosolized agents, and, in a hyperreactive airway, that can trigger a bronchospasm. A bronchospasm narrows your airway, so you can’t take in as much oxygen as your body needs to function.

General anesthesia also involves the placement of what’s called an endotracheal tube, which keeps your airway open and unobstructed during your procedure. Even in nonsmokers, the placement and removal of this tube can irritate your airway, but in a smoker’s hyperreactive airway, that significantly increases the likelihood of irritation and airway spasms. Bronchospasm can be fatal. Also, since smokers create more mucus, you might be at risk of forming a mucus plug in your endotracheal tube, which can block your airway during your procedure.⁷

Smokers are also at added risk for pneumonia and atelectasis.⁸ Pneumonia is the presence of fluid in the lungs. Smokers are at higher risk for postoperative pneumonia because they have a harder time clearing their lungs of mucus buildup. Difficulty coughing and breathing following surgery can also cause atelectasis, which is lung collapse.

Effects on Healing and Recovery

An adequate blood supply is absolutely essential to the healing process. When your tissues are healing, they need oxygen and other vital nutrients to make sure that that process goes smoothly. Since nicotine is a vasoconstrictor, it limits the flow of blood to your tissues. Instead of your tissues getting healthy blood through a giant Slurpee straw, under the effects of nicotine, it can only get blood through a tiny coffee stirrer straw. This can lead to poor wound healing, open wounds, and necrosis (death of tissues).

Smoking also causes higher carbon dioxide levels in blood, which means there is less oxygen available for your healing tissues. This results in what is called delayed wound healing.⁹ Basically, that means that your surgical wound will take much longer to heal than a non-smoker’s.

Since your wound doesn’t have adequate blood flow and takes longer to heal, you’re at a higher risk for postoperative infection, tissue necrosis and loss, more visible scarring, and need for reoperations.¹⁰

When Should I Stop Smoking Before My Surgery?

Ideally, 4 to 6 Weeks Or More

It’s preferred that you stop smoking at least 4 to 6 weeks before your surgery, but quitting before that is better for your short-term and long-term health.¹¹

After four weeks without smoking, the delivery of oxygen to your tissues will be improved, but there are still some healing processes that are impaired or delayed that will only improve with more time smoke-free.¹²

Smoke-free includes quitting smoking and eliminating secondhand smoke. Certain surgeries are more prone to have wound healing problems with smoking, so those may require you to stop smoking for longer periods. These include surgeries involving a longer scar, such as a tummy tuck or breast lift.

No Nicotine Replacements

During this period before your surgery, you might be tempted to use a nicotine patch, gum or some other nicotine replacement to curb your cravings. Unfortunately, because nicotine is what causes your blood vessels to constrict, nicotine replacements should NOT be used before your surgery either. If you’re struggling with how to stop smoking before your surgery without using nicotine replacement, talk to your primary care doctor about quitting strategies, which may include taking prescription medications.

No Smoking During Recovery

It’s important to keep in mind that even after your surgery, your body is still recovering and healing over the next several months. This means that you should not smoke, be around secondhand smoke, or take nicotine replacements during your recovery period. This is important to lower your risks of postoperative wound complications.¹³

A period of six to eight weeks of being smoke-free is preferred after your surgery, but even longer than that will benefit your healing and your overall health.

Be Honest and Play it Safe

You can lower your risks for surgical complications by quitting smoking prior to your surgery and continuing that during your recovery. Talk to your plastic surgeon or your primary care doctor for help quitting if you’re not sure how. Be honest with your anesthesia provider about your past and current smoking habits.

1. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
2. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
3. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
4. Myles, Paul S., George A. Iacono, Jennifer O. Hunt, Helen Fletcher, John Morris, David McIlroy, and Lin Fritschi. “Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery Smokers versus Nonsmokers.” Anesthesiology: The Journal of the American Society of Anesthesiologists 97, no. 4 (2002): 842-847.
5. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
6. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
7. Bryson, Ethan O., and Elizabeth AM Frost. “The perioperative implications of tobacco, marijuana, and other inhaled toxins.” International Anesthesiology Clinics 49, no. 1 (2011): 103-118.
8. Edmark, Lennart, Udo Auner, Jan Hallén, Lena Lassinantti-Olowsson, Göran Hedenstierna, and Mats Enlund. “A ventilation strategy during general anaesthesia to reduce postoperative atelectasis.” Upsala Journal of Medical Sciences 119, no. 3 (2014): 242-250.
9. Theocharidis, Vasileios, Ioannis Katsaros, Emmanouil Sgouromallis, Nikolaos Serifis,Vasileios Boikou, Sotirios Tasigiorgos, George Kokosis, and Konstantinos P. Economopoulos. “Current evidence on the role of smoking plastic surgery elective procedures: A systematic review and meta-analysis.” Journal of Plastic, Reconstructive & Aesthetic Surgery 71, no. 5 (2018): 624-636.
10. Vidal, Pedro, Juan Enrique Berner, and Patrick A. Will. “Managing Complications in Abdominoplasty: A Literature Review.” Archives of Plastic Surgery 44, no. 5 (2017): 457-468.
11. Araco, Antonino, Gianpiero Gravante, Roberto Sorge, Francesco Araco, Daniela Delogu, and Valerio Cervelli. “Wound infections in aesthetic abdominoplasties: the role of smoking.” Plastic and Reconstructive Surgery 121, no. 5 (2008): 305e-310e.
12. Sørensen, Lars Tue. “Wound Healing and Infection in Surgery: The Pathophysiological Impact of Smoking, Smoking Cessation, and Nicotine Replacement Therapy A Systematic Review.” Annals of Surgery 255, no. 6 (2012): 1069-1079.
13. Goltsman, David, Naikhoba CO Munabi, and Jeffrey A. Ascherman. “The association between smoking and plastic surgery outcomes in 40, 465 patients: an analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets.” Plastic and Reconstructive Surgery 139, no. 2 (2017): 503-511.