Cannabis Use and Post-Operative Outcomes after Breast Augmentation: A Single-Site Experience and Analysis

Goals/Purpose: The consumption of recreational and medicinal cannabis in the United States has grown exponentially, with 34.5% of persons aged 18-25 reporting marijuana use in the past year. Despite the growing acceptance and prevalence of cannabis, little is known concerning the overall effect of its use peri-operatively and on surgical outcomes. Notably, cosmetic plastic surgery clinics have reported an increasing number of cannabis users presenting for surgical consultations. The purpose of this study is to analyze the peri-operative effects of isolated cannabis use in conjunction with elective primary breast augmentation (EPBA) in a single surgeon private practice.

Methods/Technique: A retrospective analysis of 134 adult female patients undergoing EPBA was performed from August 2018 to January 2022 within a single-surgeon private practice Plastic Surgery office in San Francisco, California. Approval for this investigation was granted through the Wright State University School of Medicine International Review Board (IRB #07218).

Inclusion criteria and review parameters for the study included female patients, 18 years of age or older, undergoing isolated EPBA with either silicone or saline implants, with at least once post-procedure follow-up. Exclusion criteria included a history of abuse of opioids, cocaine or benzodiazepines, or an additional procedure at the time of surgery. Twenty-eight patients were excluded due to reporting cannabis use along with tobacco or other drug use.

Variables analyzed included: age, body mass index (BMI), cannabis use status, tobacco use, comorbidities, pre-operative, intra-operative and post-operative anesthetics, duration of surgery, and post-operative complications. Two separate cohorts were established as non-cannabis users and cannabis user-alone.

Results/Complications: One hundred and thirty-four patients (mean age: 29.5 +/- 7.0; BMI: 21.5 +/- 2.8) were reviewed (Table 1). Forty-three percent (n=58) reported isolated cannabis use. No significance was found with intra-operative blood loss or post-operative complication rate. There was no significant difference in post-operative narcotic use, peri- or intra-operative anesthetic requirement. Cannabis users were significantly younger (p<0.001, Table 1), and non-substance users elected to have larger breast implants (right implant p=0.004, left implant p=0.002, Table 2).

Conclusion: No statistically significant difference in overall peri-operative outcomes were identified when comparing cannabis and non-cannabis users undergoing EBPA in our single-surgeon, private practice study.

The study findings bring attention to increasing trends of cannabis legalization throughout the United States resulting in increased cannabis-associated patient encounters, as well as the paucity of current published data on cannabis-related outcomes in Plastic Surgery. Despite legalization, definitive cannabis product regulation is lacking which may yield variability in post-operative patient outcomes. Further research is needed to better understand the impact of cannabis use in the field of Plastic Surgery. We recommend continued awareness among Plastic Surgeons of cannabis users for thorough pre-operative patient-focused outcome discussions and surgical planning.