‘T’ Break for Top Surgery

It’s that time. You scheduled a consultation with a surgeon to get your tits off. Then your surgeon informs you that you’ll need to stop smoking 4 weeks before and after surgery. A mild panic sets in as you recall “When did I even start smoking? 16? 17?”, and you haven’t stopped since, except for those few times you were on vacation and couldn’t find weed. Why do I need to stop? And will I be able to do this surgery if I don’t? I’m not a doctor, just a trans stoner whose top surgery appointment is one week away. 

It didn’t set in for me that I was going to actually have to stop smoking weed until I scheduled my surgery date. While the doctors told me I could consume edibles up until one week before my surgery, it was recommended by three different doctors that I’ll need to stop smoking weed for a longer period. Two surgeons gave me a similar timeline: no smoking 4 weeks before and after the surgery. My PCP said I’dl have to stop only 2 weeks before (note that my PCP is transmasc and presumably the only doctor who had undergone the procedure as a patient themselves, albeit also the only doctor who wasn’t qualified as a surgeon).

There’s some mixed feedback as to why smoking, specifically, is discouraged before top surgery. Varying sources attribute it to the fact that inhaling smoke of all kinds (tobacco, vapes, herbs, etc.) can cause mucus and fluid to build up in the body, which you’re encouraged to stop before most surgeries. It should be noted that many folks who undergo top surgery will also be given drainage tubes that will be removed after the initial procedure (usually 10-14 days after the surgery). They are implemented to help the body expel any excess fluid or build up post-surgery. However, not all surgeons agree that patients need drainage tubes, and similarly, not all patients stop smoking weed.

Before I get into the folks who never took their T break, I want to mention that if there is one unanimous reason why you are asked to stop cannabis use before your surgery, it is because of its effect on anesthesia. Both anesthesia and cannabis affect the nervous system. It is known that folks who have a tolerance for cannabis will receive a higher dose of anesthesia before surgery. However, studies are still being conducted. Part of that is because as cannabis becomes more legal, scientists have more legal authority to conduct research, while simultaneously, more patients are coming forward admitting to cannabis use (though it’s unclear if more people are really consuming more cannabis or if folks just feel less stigma talking about it now). There is a study on cannabis’ effect on anesthesia from the National Library of Medicine where patients underwent an Endoscopy procedure and they found “no adverse cardiac or respiratory events were reported within 30 days…” (King, Daniel D.). The conclusion wasn’t that there is no relationship, but rather that the subject needs to be studied further with larger test groups.

All that said, have I stopped smoking weed? No. I have cut back though (confession: my version of “cutting back” still leaves me looking like a pothead to most). Sure, I like getting stoned. But as someone who has used weed medicinally for many years, and now I’m medically not supposed to? What is a guy to do but turn to personal accounts from Reddit? It seems I’m definitely not the only one in this predicament. And to my surprise, Reddit is filled with accounts of folks who used cannabis up until a week before, a couple days before, some even the night before or the day of. Pretty much everyone was fine! I didn’t read a single account of someone who said they consumed cannabis leading up to their surgery and it led to a bad experience. Most people were really emphasizing the importance that if you do choose to continue, you must be honest with your anesthesiologist about your usage. This was highlighted by horror stories (that were mainly hypotheticals, no one’s lived experience) about the “possibility” of waking up during surgery by not receiving the correct dose. There was an individual on the thread who wasn’t honest with their anesthesiologist about their usage but had a successful surgery and recovery. Now I wouldn’t take that risk, but to each their own! There was also debate on how smoking reduces the size of blood vessels, therefore decreasing blood circulation. People were using this information to suggest that smoking can cause nipple grafts to fail. However, I did my own research on that and couldn’t find any comparative conclusions. 

As cannabis becomes increasingly legal, we can only hope to shed more light on how this medicinal plant truly interacts with other medicines. I’m making a personal goal to stop 48 hours before surgery. Though my first goal was to stop 4 weeks before surgery… and that was unsuccessful (hey, I work in cannabis. Can you blame me?). So in short, consult your doctor. And long story short, if you’re going to smoke anyways, be honest with your anesthesiologist!

Now for the real quicker: I was DM’ing a Dank Dyke who responded to our story (which was about an event we hosted). They were saying, “Aww, I wish I could come out. I’m recovering from top surgery.” I mentioned I was getting top surgery soon too, and asked them how long they had to go without smoking. They said (ISTG), “So I read online that you have to quit before and my surgeon didn’t make me. Only like 48 hours before surgery”. That leads me to an even more important question: Who is their surgeon?!

King, Daniel D et al. “Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review.” AANA journal vol. 89,3 (2021): 205-212.

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