Election Section

If the potential for heart attacks and lung cancer doesn’t scare you off your cigarette habit (you may think those things just happen to other people), consider these other risks: 

• Young women who smoke are at risk for brain aneurysms, according to Dr. Thomas Kopitnik, professor of neurological surgery at the University of Texas Southwestern Medical Center in Dallas. “Nicotine attacks the cerebral blood vessels,” he said. “This is really a silent killer.” 

• “There’s definitely an increasing body of evidence that smoking is bad for you from a bone point of view,” said Dr. Michael McKee, assistant professor of surgery-orthopedics at St. Michael’s Hospital and the University of Toronto, in presenting research that found patients who smoked had less favorable outcomes after reconstructive surgery on their shinbones. “We found that the people who are smokers had a much worse outcome in a variety of different parameters, including the overall outcome, the quality of bone formed and the complication rate, compared to nonsmokers.” 

• The habit makes recovery and successful results from cosmetic surgery more problematical, says Dr. Rod Rohrich, chairman of plastic surgery at UT-Southwestern. “I won’t operate on patients who smoke because the procedure and the result will be compromised,” he says. 

Kopitnik says that the aneurysm risk is too little known, and he urges any young woman who smokes to check with her doctor about being screened for the condition. “The screening involves doing an MRI (magnetic resonance imaging) of the brain, and it could save your life if an aneurysm is detected.” 

The challenge for a doctor is to surgically clip the aneurysm before it bursts, and the MRI can detect it before it reaches the average size of a burst aneurysm – about 7 millimeters. An aneurysm that ruptures requires longer and more dangerous surgery and longer recovery time and higher medical costs. 

Kopitnik and Dr. Duke Samson, neurological surgery chairman, have operated on about 1,800 patients with aneurysms over the past decade. About 70 percent of them were women. 

The patients studied for McKee’s orthopedic research had undergone Ilizarov reconstruction, a procedure in which a circular frame is put around the leg allowing the bone to be held rigidly without having to implant hardware. “The new formation of bone depends on an adequate supply of blood and oxygen reaching that area,” he said in reporting his research at a recent meeting of the American Academy of Orthopedic Surgeons. 

The negative effects of smoking following Ilizarov reconstruction are so significant, he said, that he now insists candidates for the surgery must stop smoking first. “When someone comes to my office a needs a complex reconstruction of the tibia and they smoke, I tell them flat out, ’You need to stop smoking, and when you do, we will do your operation.” 

And in a recent edition of the Journal of the American Academy of Orthopedic Surgeons, Dr. Scott E. Porter and Edward N. Hanley provided an overview of articles published about the relationship between smoking and musculoskeletal diseases. 

Smoking has been shown to affect bone mineral density, lumbar disc health, the risk of hip or wrist fractures, and the dynamics of bone and wound healing, according to Porter, a research fellow in orthopedic surgery at Carolinas Medical Center in Charlotte, N.C., and Hanley, chairman of the orthopedic surgery department at the center. 

Perhaps not as frightening but still frightful is a less than wonderful result from a facelift or other cosmetic surgery. 

If you can’t part with your cigarettes, you might as well skip it, says Rohrich. 

“By now everyone understands how the use of tobacco can adversely affect all aspects of an individual’s health. But smoking can be problematic in plastic surgery as well,” he says. 

Nicotine gets in the way of healing because it constricts blood vessels that supply oxygen to the skin – and this can result in loss of skin as well. Patients should consider if they’d be willing to give up smoking for at least four weeks, he says. 

“I encourage them to seek a healthier lifestyle prior to proceeding or in conjunction with an elective surgical procedure, especially cosmetic plastic surgery.”