Advertisement

Is it justified to refuse breast reduction to smokers?

      Summary

      Introduction and aims

      There are several studies in the literature suggesting that smoking increases the complication rate in various plastic surgery operations. We did a study on 402 patients to see the effect of smoking on breast reduction. The objective was to raise the controversial issue of whether breast reduction could be refused to smokers who fail to stop smoking in the peri-operative period.

      Materials and methods

      The records of patients who had undergone breast reductions between April 1999 and May 2004 at the Leicester Royal Infirmary, Leicester were reviewed retrospectively for age, body mass index, smoking habits and wound-related complications.

      Results

      A total of 764 breast reductions were performed in 402 patients during this period. Twenty-eight per cent (112) of these patients were smokers. The mean age was 33.9 (range 19–68)+9.5 years in smokers and 34.4 (range 16–73)+10.6 years in non-smokers. About 90% of patients had bilateral breast reductions. Wound-related complications were seen in 35% of smokers as against 13% of non-smokers, P value<0.001. Overall, smokers had a 2.3×higher chance of developing a complication. The probability of a smoker developing wound infection was 3.3×more in comparison to a non-smoker. Smokers were also three times more likely to develop T-junction necrosis.

      Conclusion

      Smoking increases the complication rate of breast reduction significantly. Hence, patients must be strongly encouraged to quit smoking before surgery and abstain until the wound has completely healed. Stoppage of smoking in the peri-operative period should be adopted as an essential eligibility criterion for breast reduction.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shakespeare V.
        • Postle K.
        A qualitative study of patients' views on the effects of breast-reduction surgery: a 2-year follow-up survey.
        Br J Plast Surg. 1999; 52: 198-204
        • Schnur P.L.
        • Schnur D.P.
        • Petty P.M.
        • et al.
        Reduction mammaplasty: an outcome study.
        Plast Reconstr Surg. 1997; 100: 875-883
        • Rees T.D.
        • Liverett D.M.
        • Guy C.L.
        The effect of cigarette smoking on skin-flap survival in the face lift patient.
        Plast Reconstr Surg. 1984; 73: 911-915
        • Riefkohl R.
        • Wolfe J.A.
        • Cox E.B.
        • et al.
        Association between cutaneous occlusive vascular disease, cigarette smoking and skin slough after rhytidectomy.
        Plast Reconstr Surg. 1986; 77: 592-595
        • Bailey M.H.
        • Smith J.W.
        • Casas L.
        • et al.
        Immediate breast reconstruction: reducing the risks.
        Plast Reconstr Surg. 1989; 83: 845-851
        • Manassa E.H.
        • Hertl C.H.
        • Olbrisch R.R.
        Wound healing problems in smokers and nonsmokers after 132 abdominoplasties.
        Plast Reconstr Surg. 2003; 111: 2082-2089
        • Hartrampf Jr., C.R.
        • Bennet G.K.
        Autogenous tissue reconstruction in the mastectomy patient. A critical review of 300 patients.
        Ann Surg. 1987; 205: 508-519
        • Chang L.D.
        • Buncke G.
        • Slezak S.
        • et al.
        Cigarette smoking, plastic surgery, and microsurgery.
        J Reconstr Microsurg. 1996; 12: 467-474
        • Su C.
        Actions of nicotine and smoking on circulation.
        Pharmacol Ther. 1982; 17: 129-141
        • Alster P.
        • Wennmalm A.
        Effects of nicotine on the formation of prostacyclin-like activity and thromboxane in rabbit aorta and platelets.
        Br J Pharmacol. 1984; 81: 55-60
        • Sarin C.L.
        • Austin J.C.
        • Nickel W.O.
        Effects of smoking on digital blood flow velocity.
        JAMA. 1974; 229: 1327-1328
        • van Adrichem L.N.
        • Hovius S.E.
        • van Strik R.
        • et al.
        The acute effects of cigarette smoking on the microcirculation of a replanted digit.
        J Hand Surg (Am). 1992; 17: 230-234
        • Nolan J.
        • Jenkins R.A.
        • Kurihara K.
        • et al.
        The acute effects of cigarette smoke exposure on experimental skin flaps.
        Plast Reconstr Surg. 1985; 75: 544-551
        • Forrest C.R.
        • Pang C.Y.
        • Lindsay W.K.
        Pathogenesis of ischemic necrosis in random pattern skin flaps induced by long-term low dose nicotine treatment in the rat.
        Plast Reconstr Surg. 1991; 87: 518-528
        • Scott G.R.
        • Carson C.L.
        • Borah G.L.
        Maximising outcomes in breast reduction surgery: a review of 518 consecutive patients.
        Plast Reconstr Surg. 2005; 116: 1633-1639
        • Chan L.K.
        • Withey S.
        • Butler P.E.
        Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified?.
        Ann Plast Surg. 2006; 56: 111-115
        • Cunningham B.L.
        • Gear A.J.
        • Kerrigan C.L.
        • et al.
        Analysis of breast reduction complications derived from the BRAVO Study.
        Plast Reconstr Surg. 2005; 115: 1597-1604
        • Schumacher H.H.
        Breast reduction and smoking.
        Ann Plast Surg. 2005; 54: 117-119
        • Dabbah A.
        • Lehman Jr., J.A.
        • Parker M.G.
        • et al.
        Reduction mammaplasty: an outcome analysis.
        Ann Plast Surg. 1995; 35: 337-341
        • Menke H.
        • Eisenmann-Klein M.
        • Olbrisch R.R.
        • et al.
        Continuous quality management of breast hypertrophy by the German Association of Plastic Surgeons: a preliminary report.
        Ann Plast Surg. 2001; 46: 594-600
        • Lejour M.
        Vertical mammaplasty: early complications after 250 personal consecutive cases.
        Plast Reconstr Surg. 1999; 104: 764-770
        • Rohrich R.J.
        • Coberly D.M.
        • Krueger J.K.
        • et al.
        Planning elective operations on patients who smoke: survey of North American plastic surgeons.
        Plast Reconstr Surg. 2002; 109: 350-357
        • Zubowski R.
        • Zins J.E.
        • Foray-Kaplon A.
        • et al.
        Relationship of obesity and specimen weight to complications in reduction mammaplasty.
        Plast Reconstr Surg. 2000; 106: 998-1003
        • Rayatt S.
        • Nicholas W.
        • Jennings S.
        • et al.
        Smoking and elective surgery: a survey of United Kingdom plastic surgery consultants.
        Plast Reconstr Surg. 2004; 114: 605-606
        • Gariti P.
        • Rosenthal D.I.
        • Lindell K.
        • et al.
        Validating a dipstick method for detecting recent smoking.
        Cancer Epidemiol Biomarkers Prev. 2002; 11: 1123-1125
        • Jarvis M.J.
        • Tunstall-Pedoe H.
        • Feyerabend C.
        • et al.
        Comparison of tests used to distinguish smokers from nonsmokers.
        Am J Public Health. 1987; 77: 1435-1438
        • Chang D.W.
        • Reece G.P.
        • Wang M.
        • et al.
        Effects of smoking on complications in patients undergoing free TRAM flap breast reconstructions.
        Plast Reconstr Surg. 2000; 105: 2374-2380
        • Mustoe T.A.
        In the discussion “Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery by Jeffery K. Krueger, MD and Rodney J. Rohrich, MD”.
        Plast Reconstr Surg. 2001; 108: 1074-1075