If you’re a smoker undergoing surgery you’re at much greater risk of
complication.
That’s why we advise all patients to stop smoking at least three weeks
ahead of surgery and three weeks after, but it’s not just traditional
cigarettes that should be avoided – all nicotine products can sabotage your
results.
“Vaping” still risky
E-cigarettes have become increasingly popular and because they don’t
involve burning tobacco many people believe them to be the “safe” way to smoke.
Patients tell us they have stopped smoking when in fact they have simply
switched to e-cigs. Others will have turned to nicotine gum or patches to cope
with the cravings and believe this also constitutes having “given up”. Unfortunately
this is not the case.
While there is still nicotine in your body you are at an increased risk
of blood clots, small vessel damage, infection and complications with wound
healing. That’s because nicotine increases the level of a pituitary hormone called
vasopressin, which causes tightened blood vessels and inhibits blood flow.
Good blood flow is essential for carrying oxygen and
haemoglobin to injured tissues, so this results
in poorer and more prolonged healing.
What’s more, sluggish white blood cells become less effective at
fighting pathogens, increasing the risk of the wound becoming infected.
Nicotine poses even greater risk in plastic surgery
Patients undergoing any type of surgery are advised to quit nicotine,
but it’s especially important for those having a cosmetic procedure such as a
facelift, tummy tuck or breast lift.
The way the incisions are made for this type of surgery differ to, say
an appendectomy or disc operation. In the latter, the surgeon will cut straight
down through multiple layers of skin, tissue and muscle. On the other hand, for
a procedure where the aim is to lift and tighten the skin, the incisions made
are more similar to filleting a fish.
The surgeon will dissect down to a layer without blood vessels and detach
the skin from the underlying muscles. Once the skin has been lifted, it can be
pulled, stretched, moved around, and removed.
During this process normal blood flow is restricted so it’s important
the remaining blood flow is sufficiently oxygenated. Skin, fat and muscle all
need oxygen to survive – that’s why smokers are at greater risk of skin and fat
necrosis.
How nicotine constricts blood flow
If you’ve ever tried sucking a thick milkshake through a thin straw
you’ll understand the effect constricted blood vessels have on blood flow.
Nicotine causes the blood vessels to shrink down and tighten making it harder
for blood cells to pass through.
In turn, this means less oxygen circulating the body and that can lead
to tissue death. Wound healing can be delayed, scarring can be worse and even
pain levels during recovery can be higher.
More serious complications can include stroke, heart attack, blood clots, and
pneumonia. One study found smokers have a 77% higher risk of heart attack after
surgery than non-smokers.
Smoke brings extra complications
The
blood flow issues presented by nicotine are further compounded by the carbon
monoxide present in cigarette smoke. Smoking cigarettes also makes anesthesia
more complicated.
Smoke
paralyses cilia, the little hair-like structures in the lungs that help move
out debris. Consequently, debris stays in the lungs, meaning smokers’ lungs
don’t work as well as non-smokers.
Anesthesiologists
have to work harder to keep smokers breathing while under anesthesia and it is
more likely that breathing apparatus will have to be used post-surgery.
Even
secondary smoke can have a significant impact, so anyone undergoing or
recovering from surgery should avoid enclosed spaces where people are
smoking.
Stop now and reap the benefits
The sooner you stop any nicotine intake the better. Even
if you only have a few weeks to go before your surgery it can make a big
difference.
In one study of general surgery patients, quitting
smoking for three or four weeks before surgery reduced the complication rate
from about 40% to 20%.
And we know you’ll be
nervous before going into the operating theatre, but resist the urge for a
quick cigarette and chew some gum instead!
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