One of America's top plastic surgeons has said that patients who smoke following a breast lift may cut off the blood supply to their nipples.
Dr Anthony Youn, of Detroit, Michigan, has warned that the nicotine and carbon monoxide inhaled during smoking can disrupt the blood flow to parts of the body and disrupt the healing process following surgery.
"I cringe every time I see a patient for a breast lift who is a smoker," Dr Youn told CNN Health.
"I'm deathly afraid that, despite my warnings, she will smoke before or after surgery and cause her nipples to turn black and fall off.
"I've seen it before," he said.
The plastic surgeon explained that the toxins found in cigarettes can act as a "virtual tourniquet" and restrict or stop blood flow to certain parts of the body, effectively killing it.
"If you are having a breast lift or reduction and you smoke, your nipples could turn black and fall off," he warned.
"If you are having a tummy tuck and you smoke, you may get an infection resulting in a big gross open wound that will take three months to heal. "
"If you are having a facelift and you smoke, the skin of your cheek could turn black and slough off, leaving exposed fat."
Dr Youn said that he had to resort to using leeches to prevent one of his patient's nipples from falling off, after the blood supply to them was restricted by her smoking following breast lift surgery.
On the NHS, patients applying for cosmetic surgery must be non-smokers. Research has shown smokers have longer healing periods than non-smokers and can suffer greater complications from wounds and surgery.