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NEWS & VIEWS

SMOKERS AT HIGHER RISK OF COMPLICATIONS FROM BREAST RECONSTRUCTION SURGERY

Increased complications with breast reconstruction surgery linked to smoking.

The study is based on records of more than 700 women who had undergone breast reconstruction surgery with either an implant or a TRAM (transverse rectus abdominis musculocutaneous) flap.

Of the participants, 155 were current smokers at the time of the procedure, 76 were ex-smokers, and 517 were nonsmokers. Women who had quit as recently as three weeks prior to undergoing either type of surgical procedure were classified as ex-smokers.

"I routinely tell my breast cancer patients that smoking might increase their risk of complications and that most of these complications detract from the appearance and feel of the reconstructed breast."

 

The fact that the former smokers’ overall compli-cation risk was similar to that of nonsmokers surprised investigators, said Randall Yetman, MD, co-author and plastic surgeon at the Cleve-land Clinic. Almost 40% of the smokers experienced complications, such as mastectomy flap necrosis, fat necrosis, abdominal wall necrosis, seroma, wound dehiscence, and infection, compared with about 25% of nonsmokers and ex-smokers.

	Smoking Impairs Wound Healing

TOP Smoking Impairs Wound Healing

 
During the surgery, blood supply to the tissue at the reconstruction site is reduced. Smoking causes constriction in blood vessels that impairs wound healing and reduces oxygen delivery to the tissues. Therefore, women who smoke are even more vulnerable to tissue necrosis and other comp-lications in the area of the reconstruction. Wound de-hiscence, fat necrosis, and lumpiness of the recon-structed breast, for example, were all about three times more common among smokers than among nonsmokers.

"We should make sure that the issue is approached in a supportive and sensitive way."

 

Jeanne A. Petrek, MD, director of the surgical program at the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, New York City, notes that although the results of a single study cannot be considered definitive, "It is intuitive that because smoking decreases blood supply and can lead to surgical complications at other sites, it would be expected to increase the risk of the complications noted in this study.

Based on these considerations, I routinely tell my breast cancer patients that smoking might increase their risk of complications and that most of these complications detract from the appearance and feel of the reconstructed breast. And, I offer appropriate pharma-cological agents and counseling to help these women stop smoking for as long as possible before surgery."

Debbie Saslow, PhD, director of breast and cervical cancer at the American Cancer Society, agrees that, "although there are limited data, women could be told that one study indicates that complications might be increased if they continue to smoke, but that if they stop smoking for three weeks before the surgery, it could make a big difference in their results. However, many women in this situation are already experiencing tremendous fear and stress, so we should make sure that the issue is approached in a supportive and sensitive way."

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