The Impact of Nontobacco Nicotine Dependence on Postoperative Complications in Reconstructive and Aesthetic Breast Surgery Procedures

BACKGROUND: Nontobacco nicotine use, including electronic cigarettes and vaping devices, has increased substantially in recent years. While the adverse effects of combustible tobacco on wound healing are well established, less is known about postoperative risks associated with nontobacco nicotine dependence (NTND). This study evaluated the association between NTND and postoperative complications following reconstructive and aesthetic breast surgery procedures. METHODS: A retrospective cohort analysis was performed using the TriNetX research database. Patients undergoing reconstructive or aesthetic breast surgery were identified using Current Procedural Terminology codes and stratified by documented NTND within 1 year before surgery. Patients without nicotine dependence served as controls. Propensity score matching (1:1) was used to balance demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, and 1 year. RESULTS: Among 227,098 patients, 4801 had NTND and 222,297 served as controls. After 1:1 matching, 4467 patients remained in each cohort. Across all timepoints, NTND was associated with higher rates of surgical site complications, wound-related complications, wound dehiscence or delayed healing, infection, and unplanned readmission (all P