Smoking Increases Risk of Complications from Breast Reconstruction (dateline February 28, 2001)
A new study confirms the belief that smoking can interfere with breast reconstruction, increasing the risk of complications from surgery. In the study, researchers found that women who smoked were more likely to experience complications such as infection or tissue death (necrosis) than women who did not smoke or quit smoking at least three weeks prior to reconstructive surgery. It is believed that women who smoke may experience a slower rate of healing or more noticeable scars since nicotine often interferes with the bodys natural healing process. Rarely, these complications may require additional surgery.
In the study, Dr. Arvind N. Padubidri and fellow researchers from the Cleveland Clinic Foundation in Ohio compared the outcomes of 155 smokers, 76 former smokers, and 517 non-smokers who underwent breast reconstruction after mastectomy during a 10-year period. All of the women either had reconstruction using tissue from their abdomen to rebuild the breast (TRAM flap reconstruction) or had tissue expansion followed by the insertion of an implant. The results of the study show the complications, including tissue death (necrosis) at the mastectomy flap or abdominal wall, were more common in smokers than ex-smokers or non-smokers.
"Smokers undergoing reconstruction should be strongly urged to stop smoking at least three weeks before their surgery," conclude Dr. Padubidri and the team. According to the researchers, necrosis can occur during surgery because the blood supply to the tissue is reduced. However, patients who do not smoke tend to tolerate a reduced blood supply better than smokers. This may be due to the fact that smoking causes the blood vessels to constrict, increasing the risk of death to the tissue. According to the researchers, breast reconstruction should be performed with caution in smokers.
Breast reconstruction is an option for most women who have undergone mastectomy as part of their breast cancer treatment. Reconstruction may be immediate (during the same operation in which the breast is removed) or delayed for months or even years after mastectomy. There are two types of reconstruction that can be performed on breast cancer patients, muscle flap reconstruction or implant reconstruction:
- Muscle flap reconstruction: uses the patients own tissue to rebuild the contour of the breast. Tissue may be taken from the back, stomach, or buttocks. For example, in a free TRAM (Transverse Rectus Abdominis Muscle) flap procedure, a portion of abdominal skin, fat, and muscle under the skin is removed (a "tummy tuck") and transferred to the intended breast area.
- Implant reconstruction: typically involves two surgeries; one to insert a tissue expander and another to insert the actual implant. A temporary tissue expander is inserted in the intended breast area beneath the skin and chest muscle to stretch the skin. The expander remains in the breast area until the skin has been sufficiently stretched, at which time a permanent breast implant is inserted.
While smoking increases the risk of complications during surgery, side effects are possible for all patients who have reconstruction. The most common side effect of breast reconstruction is capsular contracturethe scar or capsule around the implant begins to tighten and squeezes down on the soft implant, causing the breast to feel hard. Capsular contracture may be treated with additional surgery to remove the scar tissue. Other rare complications from general surgery may also occur during breast reconstruction including: bleeding, fluid collection, infection, and problems with anesthesia.
Though some breast cancer patients are not interested in breast reconstruction, many breast specialists support reconstructive surgery as an important option for patients to consider at some point. Women are encouraged to weigh both the advantages and disadvantages of breast reconstruction with their plastic surgeons and cancer treatment team and make an informed decision based on their situation.
- The study, "Complications of Postmastectomy Breast Reconstructions in Smokers,
Ex-Smokers, and Nonsmokers," is published in the February 2001 issue of Plastic
and Reconstructive Surgery. An abstract of the study is available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&
- The February 26, 2001 Reuters Health report by Amy Norton, "Breast Reconstruction More Risky for Smokers," is available at http://www.reutershealth.com/archive/2001/02/26/eline/links/20010226elin016.html
- To learn more about breast reconstruction, please visit http://www.imaginis.com/breasthealth/reconstruction.asp