If you smoke, most surgeons will require you to quit for several weeks before and after your breast reconstruction procedure. It’s for your own good: smoking compromises your respiratory capability and overall health; inhaled carbon monoxide and nicotine from tobacco smoke restrict blood flow and increases the chances of infection, excessive scarring, and poor wound healing. Smokers are also more likely to experience necrosis, or tissue death, in the reconstructed breast. This is particularly problematic with tissue flap reconstruction when a portion or all of the new breast dies because it doesn’t get adequate blood and oxygen.
The good news: Women who stop smoking at least three weeks prior to surgery have no greater complications than non-smokers who have the same surgery.
Overweight or obese
Being obese doesn’t automatically limit your ability to have immediate or delayed breast reconstruction. In fact, obese women are just as likely to be satisfied with their reconstructive results as women who are thinner. If you are obese, however, particularly if you have a BMI of 35 or higher, you are more likely to develop infection, delayed wound healing, clotting complications and other problems, regardless of the type of reconstruction. The odds of developing problems are even greater if your BMI is 40 or more.
Three recent studies confirm what we already knew
While many studies (and surgeon’s experience with patient outcomes) have shown that smokers and heavier women generally can expect more problems after breast reconstruction, research published this year shows that both groups also more frequently need revision surgery (a separate surgery to correct cosmetic issues or healing problems). Researchers concluded that:
- Among women who had bilateral immediate, delayed or immediate-delayed breast reconstruction, those who had a BMI greater than 30 were twice as likely to experience a complication as those with a normal BMI. A higher Body Mass Index was also significantly related to infection, seroma, hematoma and delayed wound healing.
- Among 2,899 women who had breast reconstruction with any type of tissue flap, 18.2% of smokers developed wound complications compared to 8.4% non-smokers.
- Considering all free autologous (tissue flap) reconstructions at a single institution between 2005-2011, women who smoked or were obese suffered more delayed wound healing (operative wounds requiring dressing changes for longer than 3 weeks) compared to other non-smokers and thinner women who had similar reconstructive surgeries.
The bottom line: It makes good sense to do your very best to lose weight and stop smoking before your surgery. Under the very best conditions, recovery from mastectomy and breast reconstruction is physically and emotionally taxing. You'll reap the benefits of preparing yourself for the ordeal--being in the best possible shape (that includes a body that isn't compromised by the effects of nicotine or excess weight)--so that you can minimize the effects of your surgery and bounce back to your "normal" as soon as possible.
Chung CU, Wink JD, Nelson JA, et al. “Surgical Site Infections after Free Flap Breast Reconstruction: An Analysis of 2,899 Patients from the ACS-NSQIP Datasets.” Journal of Reconstructive Microsurgery Apr 24, 2015. [Epub ahead of print]
Nelson JA, Chung CU, Fischer JP, et al. “Wound healing complications after autologous breast reconstruction: a model to predict risk.” Journal of Plastic, Reconstructive & Aesthetic Surgery (2015); 68(4): pp. 531-9.
Mirzabeigi MN, Wilson AJ, et al. “Predicting and managing donor-site wound complications in abdominally based free flap breast reconstruction: improved outcomes with early reoperative closure.” Plastic & Reconstructive Surgery (2015); 135(1): pp. 14-23.