NEW YORK (Reuters Health) - Women who undergo breast reconstruction after mastectomy face a higher risk of complications if they smoke, researchers report. They found smokers are more likely than either nonsmokers or ex-smokers to have complications after

In a review of more than 700 women who had undergone postmastectomy breast reconstruction, investigators found that the 20% who were smokers had a higher complication rate than the other women. Nearly 40% suffered complications such as infection and tissue damage, compared with one quarter of nonsmokers or former smokers. In addition, smokers were more likely to have complications regardless of the type of reconstruction they had. Dr. Arvind N. Padubidri and colleagues at the Cleveland Clinic Foundation in Ohio report their findings in the February issue of Plastic and Reconstructive Surgery. In the study, the researchers looked at women who had undergone one of two types of breast reconstruction: one in which the chest skin is expanded and an implant is inserted, and one in which tissue is removed from the abdomen and transplanted to the chest. The investigators found that smokers had more complications with either type of surgery--including necrosis, or tissue death, in skin ``flaps'' at the site of reconstruction. This necrosis is a risk for any patient because the surgery decreases blood supply to the tissue, study co-author Dr. Randall Yetman told Reuters Health. But nonsmokers are better able to withstand the decreased blood supply, he explained. Smoking triggers immediate constriction in blood vessels, which along with its longer-term effects on health, makes smokers more vulnerable to tissue necrosis. Yetman said it is his policy to require smokers to quit for the 3 weeks before breast reconstruction--an abstinence period he and his colleagues have found helps cut complications.

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