Preparing for Surgery

Surgery is a big deal, and as a surgeon, I don't take recommending surgery lightly.

When I recommend surgery to someone, it's usually because we have tried several options to avoid surgery, but symptoms are still persistent, or we are in a situation where surgery is really the only reasonable option among a few options.

One thing we try to do, if we have the luxury of time, is improve a patient's odds of success with surgery by getting them in as good a condition as we can leading up to the day.

The best way to think of having surgery is preparing for a tough athletic event like a triathlon or a marathon. The stress on the body is very similar, and what we are asking the body to heal from can't be minimized.

While we don't know everything that impacts success or failure with surgery, there are several things that come up repeatedly in the scientific literature that we know make a huge impact on the odds of recovering well from surgery:

1) Nicotine and Smoking

This includes vape pens, chew tobacco, even nicotine patches. Every puff of cigarette smoke decreases blood supply to tissues for 90 minutes. The effect is also longer lasting than that. Studies across several disciplines repeatedly show increases in infection and wound healing problems in patients who use nicotine products leading up to surgery and/or continue using them afterward. The single most impactful thing you can do to improve your odds of recovering from surgery well is to quit nicotine and smoking for at least 4 weeks (better 6-12 weeks) before surgery and stay off of it until your surgeon says you are healed.

2) Diabetes

Diabetes is an extremely common medical condition impacting millions of Americans (12% of the population as of 2026). When it comes to surgery, uncontrolled diabetes is well known to increase risks for wound healing and infection that can be very serious and even life-threatening. For major surgeries, I will insist that patients have their diabetes well under control (HgA1c <7 ideally) before moving forward. Sometimes the condition we are treating is due to the elevated blood sugars, and then it becomes a much more nuanced discussion on risks and benefits of treatment.

3) Nutrition

While most people coming to see me for surgery meet all of their nutrition requirements with the standard American diet, there are some individuals who would benefit from focusing on protein leading up to surgery. For patients who we know have a hard time eating optimally for surgery, we will often order a test called an Albumin level or Pre-albumin level. These numbers give us a clue to how much available protein is in the body, which can help determine if someone will have the ability to heal after major surgery. If you are anticipating undergoing surgery, I recommend a balanced diet and to eat with a focus on nutrient-dense foods. A good rule of thumb is thinking about preparing for a triathlon and choosing foods you think would make you feel good going into the race vs. foods that may make you feel sluggish or may not provide your body with the support it needs.

4) Body Mass Index (BMI)

This number has gained a lot of attention recently as many have highlighted the flaws in using the number to understand a person's overall health. While the criticisms are warranted, there are several studies, specifically in plastic surgery, that find patients with higher BMIs having more healing problems following surgery than people with BMIs in the non-obese categories. I never recommend crash diets to patients, but I will often encourage patients who are undergoing major body-altering surgery, such as a breast reduction, panniculectomy, or a major reconstruction, to lose weight in anticipation of surgery. The reason BMI impacts healing may be due to several reasons, including extra tension on the skin, inflammation from the excess body fat, or other factors we don't entirely understand. So while this number is far from perfect, it is worth paying attention to as a means of improving the odds of surgical success.

After-surgical support and care are also critical to success, so lining up helpers before the day can be a lifesaver.

If you have questions about what you can do leading up to the specific surgery you are about to have, always ask your doctor, and they will make recommendations based on your medical history.