Abstract
Smoking is a well-known risk factor for breast cancer, and the nicotine in cigarette smoke has been associated with fibrotic changes in the breast. Although considered benign, these changes have the potential to make surgical dissection more difficult and may increase the risk of surgical complications. Here we discuss the case of a middle-aged female who was a lifelong smoker with breast cancer and who underwent a simple mastectomy. Intra-operatively, the overall breast parenchyma appeared quite firm, making tissue dissection challenging and the operating surgeon had to endure to remove the tumor and the remaining breast tissue.