Crucial aspects of smoking in wound healing after breast reduction surgery

Summary Background The aim of this study was to investigate the influence of cigarette smoking on wound-healing in patients undergoing breast reduction. Methods In our prospective study, 50 patients (25 smokers, 25 nonsmokers) scheduled for breast reduction have been evaluated. Urine cotinine levels were measured to analyse perioperative smoking habits. Urine samples were taken preoperatively and on the fourth postoperative day. Cotinine as a metabolite of nicotine allows precise evaluation of nicotine exposure. To assess the progress of woundhealing we classified secreting, instable, inflamed or necrotic wound conditions, which required a dressing after the tenth postoperative day as impaired wound healing. For statistical analysis non-parametrical tests for independent and dependent data were used. Results Ten of 25 smokers presented impaired wound healing compared to 4 of 25 nonsmokers. The median cotinine level of smokers was 1964 (783/3963)ng/cc preoperatively and 432 (148/1695)ng/cc postoperatively. Nonsmokers had a preoperative cotinine level of 18 (7/37)ng/cc and 15 (4/34)ng/cc postoperatively. Smokers who developed impaired wound-healing showed higher levels of cotinine pre- (2117ng/cc) and especially postoperatively (485ng/cc) compared to smokers with regular woundhealing (1614ng/cc and 389ng/cc). Both differences in cotinine levels were statistically significant ( p =0.03 and p =0.02). Conclusions The data of the present study confirm the negative effect of smoking on wound healing in patients undergoing breast reduction.