Cannabis Users Reported More Pain After Breast Reconstruction Surgery | Research

The takeaway

Cannabis users reported significantly higher pain scores and used more opioids after mastectomy with breast reconstruction, though cannabis was not an independent predictor after adjusting for confounders.

Plastic surgeons, breast cancer patients, anesthesiologists, and cannabis users considering elective surgery.

52% more opioid use in cannabis users (67.4 vs 44.4 MME)

What the researchers found

Cannabis users reported significantly higher pain scores at 0-12 hours (4.42 vs 3.68, p=0.018) and 12-24 hours (4.53 vs 3.36, p=0.004) post-surgery. Cumulative opioid use was higher (67.40 vs 44.38 MME, p=0.010), and more cannabis users requested prescription refills (42.5% vs 22.8%, p=0.017). However, on multivariable regression, cannabis use was not an independent predictor.

Why it matters

This adds to growing evidence that cannabis users experience more postoperative pain and require more opioids. The fact that cannabis was not an independent predictor after adjustment suggests it may be a marker for other factors that increase analgesic needs.

The numbers in context

40 cannabis users vs 197 non-users. Pain scores: 4.46 vs 3.53 overall (p=0.002). Opioid use: 67.40 vs 44.38 MME cumulative (p=0.010). Refill requests: 42.5% vs 22.8% (p=0.017). Adjusted OR for refills: 2.56 (95% CI 0.92-7.34, p=0.073).

How the study worked

Retrospective review of consecutive patients undergoing mastectomy with bilateral tissue expander reconstruction from 2021-2025. Compared 40 cannabis users to 197 non-users on pain scores, opioid consumption, and refill rates.

What this study cannot tell us

Retrospective design. Small cannabis user group (40 patients). Self-reported cannabis use. Cannabis was not an independent predictor after adjustment, suggesting confounding. Single-center study.

How to read the evidence

Retrospective single-center study with relatively small cannabis user group. The key finding that cannabis was not an independent predictor weakens the direct association.

When this study was published

2026 study using 2021-2025 data.

The bigger picture

Breast reconstruction is one of the most common procedures where pain management significantly affects recovery and satisfaction. Understanding that cannabis users may need different pain management approaches is increasingly important as cannabis use rises.

Questions still open

What confounders explain the higher pain and opioid use in cannabis users? Should preoperative cannabis cessation be recommended before elective surgery?

Common questions

Should I stop using cannabis before surgery?

This study found cannabis users had more pain and used more opioids after breast reconstruction. Discussing cannabis use with your surgical team can help them plan appropriate pain management.

Does cannabis cause more postoperative pain?

Cannabis was associated with more pain in unadjusted analysis but was not an independent predictor after controlling for other factors. It may be a marker for higher analgesic needs rather than a direct cause.

Read the original research

Perioperative cannabis use on postoperative pain in immediate alloplastic breast reconstruction.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 113, 250-256

View on PubMed ↗Publisher’s paper ↗

Citation

Qin, Nancy; Wei, Lucy; Gundlach, Carson; Webster, Theresa K; Chinta, Malini; McVeigh, Annie B; Cohen, Leslie E; Otterburn, David M. (2026). Perioperative cannabis use on postoperative pain in immediate alloplastic breast reconstruction.. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 113, 250-256. https://doi.org/10.1016/j.bjps.2025.11.013