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Plastic surgeon's bizarre breast lift warning spotlights smokers' risks

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For reasons that aren't entirely clear, smokers are more susceptible to infection with human papillomavirus, a large family of viruses that can cause warts - including genital warts. While genital warts are caused by sexually transmitted types of HPV, smoking is also a risk factor. Even taking the number of sex partners into account, women who smoke are nearly four times as likely to have genital warts as nonsmokers, according to one study. MORE FROM HEALTH.COM: 10 Crazy Ways Smokers Finally Kicked the Habit istockphoto

(CBS) If you're a female smoker considering breast lifts, consider yourself warned: smoking cigarettes could cause your nipples to fall off.

PICTURES: 13 bizarre but popular plastic surgery procedures

That eyebrow-raising warning comes from Dr. Anthony Youn, a Detroit-based board-certified plastic surgeon and author of the plastic surgery memoir "In Stitches."

"I cringe every time I see a patient for a breast lift who is a smoker," Youn wrote on CNN. "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."

In his blog, Youn relays the tale of one surgical patient who smoked too soon after surgery, causing her nipples to turn purple. Once purple, there isn't much time before the nipples turn black and fall off, he said. The only way he could prevent this from happening? Leeches.

"We went medieval," Youn wrote. Leeches sucked out the excess blood - which contained toxins - over the course of a few days to improve the patient's condition.

Is there any truth to this cautionary tale? Can smoking really cause breast lift recipient's nipples to fall off?

Definitely, says Dr. Jennifer Walden, an Austin-Texas based plastic surgeon.

"Even though it sounds graphic and kind of gross, it's important to talk about this complication so patients consider themselves forewarned," Walden told CBS News.

Walden said smoking causes blood vessel constriction, which cuts off the blood supply around breast, resulting in nipple death. Youn described smoke's toxins as a "virtual tourniquet."

But Walden warns there are plenty of other risks plastic surgery patients face if they smoke.

She said procedures that lift the skin, including face-lifts, tummy tucks, and mastectomies are especially dangerous for smokers. Smoking, she said, could cause skin death on the bottom of where the skin flap is located, which could cause chronic problems like open wounds and infections. What's more, she said smokers seeking breast augmentation with a lift could face major complications if skin flap housing the implant deteriorates.

"We'd have a real problem on our hands with the implant exposed," Walden said.

That's why Walden tells prospective patients who smoke to be tobacco-free as far in advance of surgery, at least two weeks before and after the procedure. She realizes that's no easy task, which is why plastic surgeons often refer patients to smoking cessation experts, psychotherapists, or acupuncturists to get them to quit the habit before the procedure.

After a month are recovering patients in the clear?

Walden says they can still be at risk, albeit a smaller one, if the surgical areas aren't completely healed. But why risk botching an expensive procedure, she asked?  Her advice to patients:

"The most important thing is to be honest about your smoking because you can end up with a real problem on your hands."

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