A quality project at the University of Florida Department of Surgery is working to improve eligibility for reconstructive breast surgery in cancer patients.
Jennifer Fieber, M.D., a clinical assistant professor in the Division of Surgical Oncology, said nicotine use represents a significant barrier to reconstructive surgery.
“Complication rates from reconstruction in women using nicotine products can be twice as high as in patients who don’t use them,” she said.
That’s because nicotine has vasoconstrictive properties, which narrow blood vessels and reduce blood flow. Reduced perfusion significantly elevates the risk of postoperative complications, ultimately compromising surgical outcomes and patient recovery. Due to these potential complications, patients cannot undergo reconstructive breast surgery if they’ve used nicotine within four weeks of the procedure.
A customized course of action
To address these challenges and give her patients every opportunity for access to reconstructive procedures, Fieber and her multidisciplinary team at UF Health initiated a customized smoking cessation curriculum tailored for breast cancer patients.
The curriculum was developed and adapted by Ramzi Salloum, Ph.D., a professor and the chief of the Division of Implementation Science in the UF Department of Health Outcomes and Biomedical Informatics.
“This work aligns with the goals of the Cancer Center Cessation Initiative, which was established by the National Cancer Institute to support the implementation of tobacco use treatment programs in cancer centers,” Salloum said.
The program has two pathways, each tailored to meet specific needs of the patient population. The first pathway is designed for patients undergoing immediate surgical treatment. Because these patients can’t use nicotine replacements prior to their surgeries, the course primarily focuses on counseling and non-nicotine pharmacological support to help reduce cravings.
Patients who have more time until their surgery, generally due to presurgical treatments such as chemotherapy or other targeted therapies, have access to a longer pathway with gradual smoking cessation supported with nicotine replacement therapies in addition to individual counseling sessions.
Individualized and patient focused
Fieber said a core component of the program is its individualized, patient-focused nature.
“Breast cancer care is highly personalized,” she said. “These programs enable us to balance optimal cancer treatment with access to reconstructive surgery to make a plan that takes into account patients’ goals and values.”
Although the smoking cessation project is still in its early stages, initial outcomes are encouraging, with two patients successfully completing the program in its first six months and more patients working through it.
“Patients are genuinely excited about having a targeted support system during such a challenging time,” Fieber said.
The multidisciplinary approach has meant close coordination with the Department of Surgery’s Division of Plastic and Reconstructive Surgery, aligning clinical schedules and operating room availability to streamline patient experiences.
“For patients, this coordination minimizes clinic visits and simplifies the care process during a highly stressful period,” Fieber said, noting programs like this are important because they optimize access for patients. “They allow women to have all available treatment options while significantly improving their overall health.”