When to Stop Smoking Before Surgery (and Yes, We Test for Nicotine)

When should you stop smoking if you're planning on having an elective surgery? It's a question I get constantly, and the honest answer has three parts: why, when, and what happens if you tell us you quit and you haven't.

We have our patients stop smoking for a variety of reasons. The two big ones:

1. Pulmonary complications. Smoking can increase your risk of lung complications just from having any procedure at all.
2. Healing complications. This is the one that's especially problematic in certain plastic surgery procedures, like facelifts, breast lifts, or a mastectomy.

Those operations depend on the blood supply to skin that has been lifted and moved. It's the same reason smoking comes up when I talk about nipple blood supply in a breast reduction and about who is a good candidate for nerve grafting during reconstruction.

In general, if you are a smoker, or if you use any nicotine products at all, to be honest, we're going to want you to stop at least four weeks before surgery.

Even more benefit is shown if you stop eight weeks or more before surgery. But at least four.

Four weeks is the floor, not the target. If you're given specific instructions for your procedure, those are the ones to follow.

As a patient, this can be really rough, because smoking is very, very hard to stop.

It's definitely something to talk to your primary doctor about if you're thinking about elective surgery. There are a variety of different options, even medications, that can help you stop.

And you want to start earlier than that four weeks, because you might struggle for the first couple of weeks. In general, I tell patients to start at least six weeks before their surgery.

That gives you a couple of weeks to see what works for you, and then, hopefully, that good four weeks of no smoking and no nicotine products before surgery.

I always tell patients this, because patients are surprised: we do check you for nicotine before surgery.

I know this feels yucky. Patients don't like it, because it feels like we don't trust you. But here's what actually happens:

It is so, so important with certain surgeries that there's no nicotine on board, because the complications can be absolutely horrific in plastic surgery, and we just don't want to take those risks with you.

So we are going to check your nicotine, almost certainly at your pre-op appointment, or even the day of surgery.

It is so important that you're honest with your team if you're unable to quit, because there are options we can help recommend for you.

Telling us ahead of time gives us the chance to help, which is the whole point of a pre-op evaluation that takes your health seriously. (It's also why I tell people that a consultation is not the time to be embarrassed about habits like smoking.)

• Stop smoking and all nicotine products at least four weeks before surgery. Eight weeks or more is better
• Start quitting at least six weeks out, so you have a couple of weeks to find what works
• Talk to your primary doctor. There are options, including medications, that help
• Expect to be tested for nicotine at your pre-op appointment or on the day of surgery
• If you can't quit, say so. We can help, but only if we know

And of course, we would love for you to stop and never start again. It's always best for your overall health, not just for your surgery.