How long should one quit smoking before abdominoplasty (tummy tuck) or a mommy makeover?

Smoking Cessation Before Abdominoplasty or Mommy Makeover

Patients should quit smoking at least 4 weeks before abdominoplasty or mommy makeover procedures to reduce the risk of wound healing complications and other postoperative complications. 1

Evidence-Based Rationale

Smoking significantly increases the risk of postoperative complications in plastic surgery procedures through multiple mechanisms:

• Smoking causes tissue hypoxia and ischemia, which directly impairs wound healing 2
• Cigarette smoke contains over 250 toxins including nicotine, carbon monoxide, and hydrogen cyanide that negatively affect tissue repair 3
• Smokers have a 12 times higher relative risk of developing postoperative infections after abdominoplasty 4

Optimal Timing for Smoking Cessation

Preoperative Period

• Minimum cessation period: 4 weeks before surgery 1
• This timeframe is supported by high-quality evidence and strong recommendations across multiple surgical guidelines
• Shorter periods (less than 4 weeks) have not consistently demonstrated reduced complications 1

Postoperative Period

• Continue smoking cessation for at least 2-4 weeks after surgery 2, 5
• Abstinence should be maintained until primary healing of the operative site is complete

Verification of Smoking Status

A significant concern is patient non-compliance with smoking cessation recommendations:

• More than 75% of smokers may deny smoking within 4 weeks of surgery 6
• Objective verification through urine cotinine testing before abdominoplasty has been shown to significantly reduce complications:
  • Delayed wound healing: 20.3% (with testing) vs. 41.5% (without testing) 5
  • Overall complications: 18.1% (with testing) vs. 42.3% (without testing) 5

Complications Risk Analysis

The risk of complications increases progressively with continued smoking:

• Patients who stopped smoking >4 weeks before surgery: 33.3% complication rate
• Patients who stopped <4 weeks before surgery: 52.6% complication rate
• Patients who continued smoking until surgery: 67.7% complication rate 6

Cessation Support

For patients struggling with smoking cessation:

• Nicotine replacement therapy doubles short-term abstinence rates 2
• For heavily dependent smokers, referral to a tobacco specialist is recommended 2, 5
• Intensive counseling combined with pharmacological support is most effective 1

Key Pitfalls to Avoid

1. Accepting verbal confirmation of smoking cessation without objective verification
2. Allowing insufficient time for smoking cessation (less than 4 weeks)
3. Failing to emphasize the importance of continued abstinence during the postoperative period
4. Not providing adequate cessation support for nicotine-dependent patients

Implementing these evidence-based recommendations will significantly reduce the risk of complications and improve outcomes for patients undergoing abdominoplasty or mommy makeover procedures.