One plastic surgeon has given his patients yet another reason to give up cigarettes: Smoking could make their nipples fall off during cosmetic breast surgery.
When Dr. Anthony Youn, who practices in Detroit, warned his patients of this possible surgical outcome, he wasn't just trying to scare them.
"I've actually seen it happen," he told ABCNews.com.
In his memoir, "In Stitches," Youn described a smoker whose nipples began to turn dark purple during breast lift surgery, indicating that the tiny veins in her breasts were failing to keep blood flowing properly.
Cosmetic surgeries like breast lifts and breast reductions alter the blood flow to these body parts as it is. But Youn said the nicotine and carbon monoxide from cigarettes could strangle blood flow even more. Body parts that don't receive blood flow turn from purple to black - to dead, he said.
"Among plastic surgeons, this is a very well-known complication," Youn said. "If patients don't stop smoking for three to four weeks before and after the surgery, they put themselves at risk for major problems."
The risk is not only for breast surgeries. The American Society of Plastic Surgeons recommends that patients stop smoking well in advance of any cosmetic procedure. In 2009, a report to the American College of Surgeons noted that smoking could complicate the management of anesthetic during any surgery and also hinder a patient's recovery.
Youn said patients who didn't kick their smoking habits while undergoing nips and tucks were at a high risk for wounds straight out of a horror movie.
Smoking can, for example, damage or kill the skin of the face after a face-lift, leaving exposed tissue. Smokers getting a tummy tuck could see the skin and fat of their abdomens die off, "leaving a big crater," Youn said.
Even secondhand smoke could lead to these horrifying complications, which can result in months of recovery and a couple thousand dollars in extra medical expenses.
Youn said he found that the most effective way to get his patients to kick their smoking habit was to tell them the truth about these very real risks.
"Smokers are addicted, and unfortunately, in order to get them to stop smoking, sometimes you have to shock them," Youn said. "And many of my patients say, 'Thank you so much for telling me this because now I really am going to quit.'"