It is universally accepted that smoking is bad for you and your health. Not only is it unequivocally associated with premature aging, both physiologically and in appearance, but also with an increased incidence of numerous diseases and cancers as well as a reduced quality of life. Smoking also significantly elevates the rate of complications and other untoward issues in several cosmetic and reconstructive breast surgical procedures.

For the more than 23 years that I have been practicing in the Scottsdale and Phoenix areas, I have been routinely informing and warning my smoking patients of the substantially elevated risks that smoking has on many surgical procedures and their outcomes. The chemicals in cigarettes cause a constriction (narrowing of the diameter) of the blood vessels in the tissues which results in a decreased blood supply to the tissues and therefore less of the vital oxygen and other nutrients important for cell survival and healing. For areas that have undergone surgery, this can directly translate into delayed or improper healing or worse – lack of survival of some tissues which may then require the need for corrective reconstructive procedures such as skin grafting.

Though I do make my patients aware of the risks that smoking has on their health and surgery, for certain procedures I do request and many times demand that they at least stop smoking for a specific period of time prior to their scheduled date because the impact from such smoking can be far more severe. The breast procedures at substantially higher risks for healing problems such as skin necrosis (where the skin turns black and dies) include primary (immediate) breast reconstruction, secondary breast reconstruction in those who have had radiation treatments, breast reductions and breast lifts.

Patients having these procedures are instructed to stop smoking starting one month prior to their surgery until at least two to four week postoperatively. It takes but a few cigarettes just prior to or after surgery to jeopardize the healing process. Chronic smokers who are able to stop smoking during this period of time do better than those who continue even at reduced levels.

To put this in even clearer perspective and provide additional motivation, I ask my patients whether it worth the prolonged healing time, expenses, inconveniences, compromised aesthetic results and the possible need for additional surgery just to continue smoking. Stated this way, most will make a serious effort to quit.

For more information on any plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast revision surgery is very commonly performed for both cosmetic and reconstructive breast procedures including breast augmentation, breast lifts, breast reduction and breast reconstruction. The reasons can be many including issues relating to size, shape, firmness, asymmetries and changes over time.

The following patient of mine illustrates an example of revisional breast surgery in a woman who underwent a subcutaneous mastectomy with immediate reconstruction 25 years ago in order to reduce an elevated risk and strong family history of breast cancer. Seeking to further improve the results, she had several subsequent procedures in attempts to improve the results. I was consulted because she was very dissatisfied with the appearance of her breasts and also was experiencing significant chronic pain in both sides.

Subcutaneous mastectomy before breast revision

After surgery

Before - side view

After surgery

Before surgery - oblique view

After surgery

The photos of her breasts clearly delineate the substantial deformities, asymmetries and implant malposition with the right side being situated too high. You can appreciate the extensive irregularities of contour and skin folds as well as the relatively low positioning of her nipple-areola complexes in relation to the breast mounds.

To achieve a more desirable result, her breast revision entailed the precise release and removal of the deforming scar tissue along with reshaping of her breasts and replacing her implants with much more appropriately configured and sized implants. In addition, I employed AlloDerm® dermal grafting material for both breasts which served to provide greater support of the implants, contouring, durability and increased soft tissue thickness.

As you can judge from the photos, the transformation from the breast revision surgery resulted in breasts that were much more acceptable and desirable in appearance which made her quite happy and thankful and boosted her self-confidence.

If you have any questions regarding breast revision surgery whether for cosmetic or reconstructive issues or for any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona