If you continue to smoke, we may have a problem: smoking's effects on plastic surgery.

Smoking causes various aero-digestive neoplasms, some cardiovascular diseases, respiratory pathologies, and cardiovascular disorders. Surgeons have observed an association between impaired wound healing and smoking. In plastic surgery, cigarette smoking should be forbidden before and after surgery to prevent poor surgical results. In this retrospective study, we presented four major complications related with continuous smoking immediately after surgery. Although we have strongly forbidden smoking for every patient, 4 patients did not follow our advice and continued to smoke. One of them had a breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap. Another patient had an abdominoplasty. The third and fourth patients had digital replantation and they were chronic smokers. After their poor surgical outcomes, these heavy smokers received close supervision, but managed to smoke, anyway. Education, psychologic consultation, and sometimes refusing to perform aesthetic or reconstructive surgery are required to minimize postoperative complications.