Breast Reductions on Smokers: Proceed with Caution

Recently, I refused to perform breast reductions because the patient was a heavy smoker.  My concern was for her well-being.  Smoking is the single greatest contributor to complications after all types of plastic surgery.

However, one of my colleagues did reduce this patient's breasts, and the patient healed uneventfully.  She sent me the following note:

I have heard all of the issues related to smoking and breast reduction.  In fact, you told me personally you would not perform a reduction on me unless I stopped smoking.

I had a reduction in October.  I had cut down to two cigs a day, and I have had NO problems at all.

My question is...

• Do you think everyone is different in healing?
• Or did I just get lucky?

My plastic surgeon has 34 years of experience, and he didn't seem too worried that I smoked!

I am very happy that she had a successful breast reduction, and I think that she is correct--twice:

1. Different patients do heal differently.
2. And, I do think that she got lucky.

However, I have to think that my colleague should have been VERY worried that she smoked.

Breast reduction surgery has a very high satisfaction rate, despite the fact that about 30-40% of breast reduction patients have some form of complication.  Most are minor (stitches split a little bit, mild infection requiring oral antibiotics, etc.), but some are major (loss of the nipple and areola, breakdown of the incision lines, etc.).

According to most research studies, certain patient factors do increase risks....

• obesity
• diabetes
• heart disease/blood vessel disease/atherosclerosis
• tobacco use

Certainly, overweight, diabetic smokers (ODS) are at much higher risk of problems than skinny, non-diabetic non-smokers (SNN).  However, there are the lucky ODSs who have no problems, and there are unlucky SNNs who have complications.

I prefer that patients quit smoking before elective plastic surgery because it is the one risk factor that the patient and I can (relatively easily) control.  Even reducing her cigarette use to just two cigarettes per day definitely helped this patient achieve a favorable result.  In fact, since she reduced her tobacco use so much, I bet that she could quit entirely. With the newest anti-smoking medications (such as Chantix), tobacco cessation is very possible!

And quitting smoking will be so good for the rest of her too, not just her healing breasts!  She'll save money, have more energy, have better skin, reduce her risk of cancer, reduce her risk of heart disease, reduce risks involved with other surgeries that may be necessary in the future, etc.

I do care about my patients!  Sometimes refusing to do surgery is the "tough love" that is the right decision.  Obviously, I get paid to do surgery; I don't make money by turning patients away.  However, an ethical doctor must do what he thinks is right, even if it hurts his wallet!

In this situation, I am proud to have stood by my convictions.  I'm glad that consulting with me impressed upon her that tobacco is a danger.  Perhaps, had I not admonished her to quit before surgery, which convinced her to at least cut back to just two cigarettes per day, she would have been in trouble!

Comments

[Texas breast reduction]

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