Active smokers have a marked impaired ability to heal and increased risk of poor healing with the mastectomy and the reconstruction. With implant surgery smokers are at higher risk of implant infection, mastectomy flap necrosis, and reconstructive failure. With abdominal flap surgery smokers are at higher risk of infection and delayed healing of the abdomen. Smoking increases the risk of total reconstructive failure. Nicotine replacement therapy (patches, e-cigarettes, gum) also have a poor effect on wound healing and are not much better than smoking. It is encouraged to be off of all nicotine products four weeks prior to surgery.