Smoking and plastic surgery are like oil and water, especially if you undergo breast lift, tummy tuck or facelift. Most shocking news is that a smoker who undergoes a breast lift may lose her nipples.

According to a Detroit plastic surgeon, as told to CNN on December 5, 2011, “The nicotine in cigarettes and the carbon monoxide contained in cigarette smoke can diminish blood flow to various parts of the body. These toxins act as a virtual tourniquet. If the blood flow to a particular body part becomes greatly reduced or halted, the body part dies.”

He is speaking from experience. While undergoing a breast lift, he saw a smoker’s nipples turn purple. He understood that purple is the precursor to black and black is the precursor to “falling off.” Think frostbite.

To save the patient’s nipples, the surgical team resorted to a medieval practice. They used leeches to suck out the excess venous blood from the body part, which acted as an attachable vein. The CNN article does not indicate where the leeches came from. If they are standard equipment in an OR, this is not a well known fact. The leeches drained the old blood, turning it from unhealthy purple back to healthy pink. The team persisted with the process, which took several days, until the body part grew new blood vessels to do the leeches’ work.

Now, in addition to a Surgeon General’s warning on cigarette packs, this plastic surgeon offers his own warning, which is not limited to breast lifts but extends to tummy tucks and facelifts. Smokers who undergo tummy tucks may get an infection resulting in a large open wound that takes three months to heal. If you’re a smoker undergoing a facelift, the skin on your cheek may turn black and slough off, leaving exposed fat.

When undergoing any plastic surgery procedure, make sure your surgeon is board-certified in plastic surgery by the American Board of Medical Specialties. When asked about your smoking habits or any health conditions you have or medications you are taking, do not be shy. Full disclosure will lead to the very best results.