Non-Tobacco Nicotine Dependence Is Associated With Increased Early Postoperative Complications Following Reduction Mammaplasty.

Abstract

Background: Within the past decade, non-tobacco nicotine dependence (NTND) has become more prevalent. However, the impact of non-tobacco nicotine products on breast surgery remains less explored. Despite limited evidence, plastic surgeons routinely advise nicotine cessation regardless of source, which underscores the need to define the specific risks associated with NTND.

Objectives: The present study sought to assess the effect of preoperative NTND on postoperative complications and revisions in patients who underwent reduction mammaplasty.

Methods: The Research Network on TriNetX, a federated global database, was queried. Patients with a history of breast cancer or tobacco product usage were excluded. Two cohorts were formed: patients diagnosed with preoperative NTND (n=1,432) and those without any documented history of nicotine dependence (n=44,149). A 1:1 propensity score-matching was performed for demographics and comorbidities. Primary outcomes evaluated postoperative complications at 30 days and 90 days. Secondary analysis assessed breast deformity and surgical revision at 2 years.

Results: Following 1:1 matching, 1,424 patients remained in both cohorts. At 30 days after surgery, the NTND cohort had significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications (p<0.05). Within 90 days post-op, patients with NTND continued to have significantly elevated risks for these complications (p<0.05). However, no significant differences were observed for postoperative breast deformity and revision at 2 years.

Conclusions: Although preoperative non-tobacco nicotine use is not linked to increased rates of long-term deformity and revision rates, it is associated with significantly higher risks of early postoperative complications following reduction mammaplasty.