To investigate the influence of smoking on the occurrence of complications in patients undergoing breast reduction, a retrospective case note study was performed. Seventy-one patients who had 118 reduction mammoplasties between April 2001 and March 2002 were analyzed; 15.5% (11/71) of all patients suffered a complication. Ten complications were of infective nature. There was no case of partial or total nipple necrosis. Factors like past medical history, breast history, drug history, age, body weight, and resection weight did not influence the development of complications (P > 0.4, respectively). Smoking, however, was found to be a significant risk (P < 0.05). The risk to develop complications after reduction mammoplasty was calculated to be more than 3 times as high when compared with nonsmokers.