Smoking can make your nipples fall off
December 5th, 2011
09:34 AM ET

Smoking can make your nipples fall off

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

I cringe every time I see a patient for a breast lift who is a smoker. 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.

Yes. Smokers who undergo breast lifts are at great risk of losing their nipples.

I’ve seen it before.

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, that body part dies.

In my memoir “In Stitches,” I told the story of a smoker whose nipples turned purple while undergoing a breast lift surgery. Purple is the precursor to black. Black is the precursor to falling off. To save the patient—and her nipples - we turned to the only treatment available.

We went medieval.

We used leeches.

Because of the mechanics of blood flow, when the blood supply is inadequate, which occurs with smoking, the tiniest veins often fail. This insufficiency results in a backup of old (venous) blood in the body part, causing it to turn purple. If the backup of old blood is serious enough, the purple color may eventually turn black. That’s when we know the body part - toe, finger, or nipple - is dead.

We use leeches to literally suck out the excess venous blood from the body part, acting as an attachable vein. The leech drains the old blood, causing it to turn from unhealthy purple back to healthy pink. We place leeches intermittently until the body part grows new blood vessels to do the leeches’ work. This can take several days.

Not long ago, during a consultation for a breast lift, a patient, Susan, admitted to being a pack-a-day smoker. I informed her that smoking can cause difficulty in healing and instructed her to quit smoking at least one month before surgery and to stay off cigarettes for at least a month afterward. Several months later, when she arrived at the hospital for her breast lift, she smelled like an ashtray.

“Susan, I thought you quit smoking.”

“I did. OK. For a while. It’s really hard to quit, Dr. Youn.”

“I know,” I said. “But this is a big deal. There could be major healing problems if you smoke before or after surgery.”

“I understand. But I want to go ahead with the surgery anyway. It’ll be fine.”

She wasn’t hearing me. I needed to get through to her. “Susan, listen to me. If I operate on you, your nipples could turn black and fall off.”

Her eyes widened. “You mean… I’d have no nipples?”

“No nipples. That’s what smoking can do.”

Susan flushed. She raised her voice. “Dr. Youn, I took a week off work for this surgery. I had to put my whole life on hold for an entire week. If you told me I’d lose my nipples from smoking, I would’ve quit for good. This is your fault.”

Yes. Seriously. Susan blamed me for the inconvenience.

Thanks to her, I’ve changed my policy. In addition to the Surgeon General’s Warning that appears on cigarette packages, I now offer the Plastic Surgeon’s Warning to all my patients who smoke: If you are having a breast lift or reduction and you smoke, your nipples could turn black and fall off. 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.

Imagine yourself looking like “Two-Face” from “Batman: The Dark Knight.”

And do you really want me to reach for the jar of leeches?

Smokers, you have been warned.

soundoff (343 Responses)
  1. Eddie

    What POSSIBLE crapola can they come up with next.

    December 5, 2011 at 18:52 | Report abuse | Reply
    • Mark

      I smell a smoker in denial....

      December 5, 2011 at 19:59 | Report abuse |
    • MedStudent

      He is not lying. I have seen it with my own eyes.

      December 6, 2011 at 18:46 | Report abuse |
    • Seabass

      It happened to my freinds finger , she almost lost it because she refused to stop smoking like her Doc said too . It's not crapola .

      December 6, 2011 at 21:18 | Report abuse |
  2. bob


    December 5, 2011 at 19:26 | Report abuse | Reply
  3. James

    Both smoking and frivolous cosmetic surgery are pretty disgusting I think.

    December 5, 2011 at 19:40 | Report abuse | Reply
    • Leon

      I concur whole heartedly....

      December 6, 2011 at 20:11 | Report abuse |
    • Judy

      Don't assume that all plastic surgery is frivolous. Until you have walked in the shoes of those having it you have no idea of why they want/need it. I have a breast reconstruction after a mastectomy and had a breast reduction at the same time to get some symmetry. There are many reasons people may require plastic surgery.

      February 24, 2012 at 06:39 | Report abuse |
  4. Anne

    I quit smoking a month before my tummy tuck in July, because my doctor showed me photos of smokers' wounds that failed to heal. I'm so glad I quit - and glad to have that roll of fat gone from my waist! (To all those people who say "Just exercise and you can have a flat stomach," I say, Have three kids and you'll find out that exercise won't get rid of your ab flab.)

    December 5, 2011 at 20:32 | Report abuse | Reply
    • Julie

      Even better reason to quit smoking, your kids. Great job. I hope you never smoke again and are around for your kids for a long time.

      December 5, 2011 at 23:01 | Report abuse |
    • Marina

      I have been thinking of getting a tummy tuck. Is it risky , painful, expensive? How long did it take you to get back? Sorry, too many questions, but will help me 🙂

      December 6, 2011 at 13:34 | Report abuse |
    • Chirp

      Wow! That sounds like a great side effect of surgery!

      October 17, 2012 at 18:48 | Report abuse |
  5. Margo Zargo

    I'm reading this while smoking. I figuare that there are too many people in the world and smoking will get rid of lots of us, so the US government will save lots of money when it finally passes its health care bill. I really deserve a pat on the back for this.

    December 5, 2011 at 20:44 | Report abuse | Reply
    • Eggsacklee

      LOL too funny........

      December 5, 2011 at 21:47 | Report abuse |
    • Smoking

      Smoking Causes The most health care costs. So you aren't saving us any money you're costing us. We should tax you more.

      December 5, 2011 at 22:11 | Report abuse |
    • ib42

      Just what I wanted to hear! I'm starting again. Let's start a movement...call it WHYQUIT?

      December 5, 2011 at 23:36 | Report abuse |
    • sam

      I say, what an idiot.......

      December 6, 2011 at 10:04 | Report abuse |
    • thizz

      @Smoking. Wrong, Obesity cost health care the most.

      December 6, 2011 at 12:26 | Report abuse |
    • sam

      The only problem is its ALCOHOL killing everyone,and not only the DUMB DRINKERS of this Poison But others as well...Its not smoking,Its ALCOHOL Killing everyone

      December 6, 2011 at 13:59 | Report abuse |
    • Leaf on the Wind

      Hey Smoking, we ARE taxing smokers more. Do you know what a pack costs these days, and how much of that cost is federal and state taxes?

      December 6, 2011 at 19:04 | Report abuse |
    • Mole

      It won't save money, it will cost us all millions more.

      December 6, 2011 at 23:11 | Report abuse |
    • Bill Mosby

      Interesting name, Margo Zargo. I once knew twins named Zelda and Zelma Ziegler. For what it's worth, lol.

      December 7, 2011 at 00:51 | Report abuse |
    • corge glooney

      I'm with you Margo. But I've only been smoking for 50 years, so it may be a while. But I AM trying.

      December 7, 2011 at 06:50 | Report abuse |
    • Laurie

      Margo: You will definitely feel differently if you are diagnosed with lung cancer. My sister was a smoker since she was 13. She died at the age of 44 from lung cancer. She used to say the same thing you are saying but at the end she would have given anything for more time. Her sons were only 14 and 17 when she died. She didn't even make it to her sons high school graduations, college graduations and was not at her youngest son's wedding. We miss her so much.

      December 7, 2011 at 11:26 | Report abuse |
    • Steven

      Smokers are far from the largest strain on healthcare. Fat people are. More health problems stem from obesity than any of the harmful vices people have. At least a meth addict has the decency to die in a few years. A fat person drains precious healthcare dollars for a lifetime while continuing shoveling food into themselves.

      December 7, 2011 at 23:41 | Report abuse |
    • Marybeth

      You're not only getting rid of yourself, your second hand smoke is harming others who don't smoke! Wake up. Smokers are self-haters in denial.

      December 8, 2011 at 19:05 | Report abuse |
  6. smum

    Is this charlatan a real doctor? A graduate of where... the Michele Bachman School of Medicine where she learned that the HPV vaccine causes mental retardation? ? This country is becoming dumber and dumber every day, and the gullible are more gullible every minute. Have we lost our collective ability to think and analyze and question, for once, the constant fear-mongering BS we hear about everything?

    December 5, 2011 at 21:15 | Report abuse | Reply
    • .

      you're retarded

      December 6, 2011 at 00:00 | Report abuse |
    • Dr. Z

      smum, I'm guessing you're not a doctor. I agree there are crazy assertions about medical interventions out there, but you may want to take a closer look at this one. Say, in a medical textbook. Robbins Pathology would be a good start...

      December 6, 2011 at 00:46 | Report abuse |
    • specford

      Everything the plastic surgeon said is true. As a cancer doctor many ladies choose mastectomy and reconstruction, and indeed there is a higher rate of micro-vascular failure among smokers. The surgery in these cases is not "frivolous cosmetic surgery" as one poster implied. And yes leeches are a commonly used method of "leeching" out swollen blood engorged wounds to prevent tissue death (look it up, "medical leeches")

      December 6, 2011 at 03:50 | Report abuse |
  7. Brad

    Nicotine is a vasoconstrictor and increases clot formation (both of which can lead to decreased bloodflow to parts of the body). What part of that sounds inconsistent with this Dr's description of its effects? Do you really think a plastic surgeon would be fearmongering if he didn't have a good reason? He's in the business to make money, not scare people away from surgery.

    December 5, 2011 at 22:27 | Report abuse | Reply
    • Ecce

      Exactly – NICOTINE is a vasoconstrictor. It's not "toxins in cigarettes and carbon monoxide." The doctor here is delivering the right message with the wrong support. If nicotine is the problem, and nicotine can come in many forms, then call it out as the problem. But don't mix facts and say that it's cigarettes' toxins – nicotine is a drug, just like caffeine is a drug. Are people being moralistically chastised for drinking a pot of coffee? They might be getting told to cut down to lower their blood pressure, but no one is calling them leeches on the healthcare system for it....

      (This is coming from a happily-quit smoker)

      December 6, 2011 at 12:04 | Report abuse |
    • Huh?

      ^ What was the doctor supposed to say instead then, it's ok to still use nicotine-free, carbon monoxide-free cigarettes? Nice try. You might have quit, but it looks like smoking has still left a stain on you.

      December 6, 2011 at 16:38 | Report abuse |
  8. Brian

    Of course plastic surgery is perfectly safe for non-smokers right?

    December 5, 2011 at 23:26 | Report abuse | Reply
    • Aeroman

      I don't remember anyone saying that. Did you have trouble reading the article?

      December 6, 2011 at 02:06 | Report abuse |
  9. Craig

    When will people learn to take responsibility for their actions? All too often people make bad decisions and quickly blame someone else, instead of blaming themselves. Remember the days before product liability and all the safety warnings? All of the idiots would take themselves out of the gene pool, not we have to protect them...... This lady probably would have used her hair dryer in the tub if the label didn't tell her not to.....

    December 6, 2011 at 01:05 | Report abuse | Reply
    • Feast of Beast

      Good post. I agree! 🙂

      December 6, 2011 at 11:51 | Report abuse |
  10. Kabra

    This is real folks. And not just with plastic surgery, smokers who aren't having surgery can lose fingers and toes, even entire hand or foot due to vasoconstrictive effects. Google Buerger Disease. In medical school, we get to see the really gruesome pics thanks to people with unhealthy behaviors!

    December 6, 2011 at 01:18 | Report abuse | Reply
    • Kathy

      It's very real. Smokers don't heal. A reputable plastic surgeon would have called off this surgery as soon as he sensed that the patient was still smoking. I have a friend who is a plastic surgeon, and she won't perform any facial surgery on smokers. Period. Just too risky.

      December 6, 2011 at 13:31 | Report abuse |
  11. ibrad

    So...If Newt smoked would his head fall off ?

    December 6, 2011 at 01:30 | Report abuse | Reply
    • akt1006

      We could only hope!! LOL

      December 6, 2011 at 11:02 | Report abuse |
    • Rob


      December 7, 2011 at 00:10 | Report abuse |
    • Daniiel

      Hello, My daughter Stephanie took some prsicripteon drugs, I was told, and died in her sleep. Her birthday is tomorrow. I just saw on channel WGN a message to parents to watch out for their prsicripteon drugs from Partnership at Drugfree.org. I had seen it before but did not know what it meant. I grew up in the 70 s and had know idea about perscription drugs. The message needs to be more clear. Please add Prescription drug abuse is of critical concern in the Commonwealth, devastating families and communities and killing more people than car crashes each year. I can tell my story. It must be why it happened. Please let me know how I can be involved. Sincerely, Lauren Brennan

      September 12, 2012 at 02:13 | Report abuse |
  12. Classic

    This is the single funniest headline on a news site in while.

    December 6, 2011 at 01:45 | Report abuse | Reply
  13. Nadine

    Headline and first bit of story is misleading. It makes you think that it could happen to any woman. Then you find it is the women who smoke and have had plastic surgery. Not the same as the headline and start of article.

    December 6, 2011 at 01:54 | Report abuse | Reply
    • Rich

      The headline got you to read the article. I'd say it was a pretty good one...

      December 6, 2011 at 16:46 | Report abuse |
  14. waheid

    Beam me up, Scotty. There's no intelligent life here.

    December 6, 2011 at 02:51 | Report abuse | Reply
  15. mmi16

    Does this also apply to male enhancement surgeries????

    December 6, 2011 at 03:18 | Report abuse | Reply
  16. Mad Cow

    If you master bait too much your wee knee will fall off.

    December 6, 2011 at 03:18 | Report abuse | Reply
    • Feast of Beast

      Also, if you don't switch hands, it will get bent to one side over time. I know. 🙁

      December 6, 2011 at 11:49 | Report abuse |
  17. non smoker

    Stop critisizing ! Who has the degree here ?! If the DOCTOR says STOP smoking, he does it for a reason. In my opinion and knowledge, he didn't tell her EXACTLY what happened because she wouldve gone into stress mode, and stress causes wounds to heal slower if not STOPS healing ! Gosh, why did she go for the sugery if she wasn't willing to LISTEN.

    December 6, 2011 at 04:39 | Report abuse | Reply
    • kadrock

      unfortunately, it boils down to the person. in my opinion, cosmetic surgery means you 1. hate urself 2. found an easy way to fix it. these are people who can't think rationally, and, again unfortunately, there r people out there that will do the deed, i.e. the doctor gettin paid to do it, but giving his warnings, and the person refusing to listen, it's on them, not the doctor, you can fix a fat stomach...not stupid

      December 7, 2011 at 00:15 | Report abuse |
    • Judy

      Kadrok you forgot 3. Are so disfigured that plastic surgery is the only way for you to feel 'normal' again. Believe me many people have to think long and hard before going ahead with plastic surgery and it is very scary to be going under the knife not knowing how it will turn out and whether you are just making things worse.

      February 24, 2012 at 06:49 | Report abuse |
  18. non smoker

    Stop critisizing ! Who has the degree here ?! If the DOCTOR says STOP smoking, he does it for a reason. In my opinion and knowledge, he didn't tell her EXACTLY what happened because she wouldve gone into stress mode, and stress causes wounds to heal slower if not STOPS healing ! Gosh, why did she go for the sugery if she wasn't willing to LISTEN.....

    December 6, 2011 at 07:55 | Report abuse | Reply
  19. Palfrei

    Smoking can make your life fall off.

    December 6, 2011 at 08:08 | Report abuse | Reply
    • thizz

      and by not smoking your life will still fall off.

      December 6, 2011 at 12:28 | Report abuse |
  20. mort

    As if there needed to be further evidence or another reason NOT to smoke. Aside from the health reasons not to smoke, it makes you stink, your breath stink, your hair and clothes stink, your teeth look ugly and your skin looks ugly. It also makes people think that you are weak minded since you choose to do something so horrid. If you are a smoker, you are less than.

    December 6, 2011 at 09:55 | Report abuse | Reply
    • sam


      December 6, 2011 at 10:06 | Report abuse |
    • Meany

      Talking down to people and calling them "less than" is pompous, mean – and it doesn't help anyone. Smokers are fully aware of the risks and consequences – it's called addiction, genius. I'm sure you live your life perfectly and have never had a vice. You could say the exact same thing about overweight people, and I am certain you would get a verbal punch-out. I hope no one in your family ever gets addicted to anything or has an OCD (food, drugs, alcohol, cigarrettes, etc) having you as a support system. Sheesh.

      December 6, 2011 at 10:07 | Report abuse |
    • kadrock

      the only time if heard that kind of talk is from being around an ex-smoker check the mirror

      December 7, 2011 at 00:09 | Report abuse |
  21. Acupuncture

    I am (was?) a pack a day smoker. I just did an acupuncture treatment last week for an unrelated health problem, and an awesome side effect is that cigarette smoke now makes me want to hurl!! I can't believe it. I tried to light up out of habit, and I couldn't get down more than 3 puffs. It's like a miracle. I would highly recommend trying acupuncture – $60, one time, 2 hours....and I'm pretty certain I am going to be a non-smoker now.

    December 6, 2011 at 10:02 | Report abuse | Reply
    • EssEss

      I'm pretty certain you are delusional. Acupuncture is only known to treat thick wallet syndrome.

      December 6, 2011 at 16:37 | Report abuse |
    • kadrock

      nice plug

      December 6, 2011 at 23:54 | Report abuse |
    • Really?

      The money you'd lose is certainly less expensive than cigarettes everyday. Certainly worth a try. My in-laws together have lost over 100lbs through acupuncture.

      December 7, 2011 at 17:52 | Report abuse |
  22. Feast of Beast

    I used to smoke 2 1/2 packs a day.It wasn't easy, but I quit before I might get sick and die. But now, I see losers suing the tobacco companies for billions (and winning) because they didn't have the will to quit and they hurt themselves. That's no different than eating fast food until you're a fat pig and then suing the burger chain. Yes, it's addictive. So what? If I can quit, so can anybody. But it's so much easier to blame someone else, courtesy of class-action lawyers. No one twisted my arm to get me to smoke. It's a personal decision that carries consequences. Why should smokers be awarded for being weak?

    December 6, 2011 at 11:48 | Report abuse | Reply
  23. Emkat

    BEST headline ever!!!

    December 6, 2011 at 12:03 | Report abuse | Reply
    • Kit

      Good Lord, how old are you...twelve??? Oooooo, someone said the "n" word. Grow up!

      December 6, 2011 at 12:25 | Report abuse |
  24. Kit

    When I read articles like this I always wonder how my mother's generation survived when there's so many hidden horrors in just about everthing we do....did their ignorance of these "facts" cause them to be immune from the effects? Seriously, next they'll tell us that smoking causes bunions. No matter how many horror stories (and lies) the medical probession and our government come up with, there will always be smokers. Everyone needs to get over it and move on with their lives.

    December 6, 2011 at 12:23 | Report abuse | Reply
    • MedStudent

      smoking has been causing problems throughout time. most of these reconstructive surgeries are fairly new and more widely used today.

      December 6, 2011 at 18:51 | Report abuse |
    • Mickey

      Ah, another nicotine addict in denial. The reason the rest of us aren't going to just "get over it and move on with our lives" is because smokers are poisoning us too. I should know, as I am very sick due to second-hand smoke.

      December 7, 2011 at 21:33 | Report abuse |
    • Kevin in Hope, AR

      If you want to smoke, knowing the risks, that's up to you, as is the decision to just go commit suicide. However, when my tax dollars are going to save your life because you just kept smoking, then it becomes my business. I think people that choose to smoke should put up a bond large enough to cover any additional medical needs they may have to guarantee the government doesn't end up paying to keep trying to save their life. Instead of launching into a nicotine fit, just think about it for a moment.

      December 28, 2011 at 17:26 | Report abuse |
  25. Tony

    They should offer this to men.
    Wha the hell do we need them for anyway??

    December 6, 2011 at 12:59 | Report abuse | Reply
    • Really?

      ahh...nursing babies? free milk if you can master it.

      December 7, 2011 at 17:55 | Report abuse |
  26. sam

    And booze can rip your heads off

    December 6, 2011 at 13:55 | Report abuse | Reply
  27. dddd

    so it's smoking, not unnecessary elective comestic surgery that causes all these problems?

    December 6, 2011 at 15:59 | Report abuse | Reply
    • briskmojo

      i don't remember a point in the article when it was said something was unnecessary.

      December 8, 2011 at 03:56 | Report abuse |
  28. DGirl101

    My father who smoked a pack a day had emergency back surgery that involved removing bone from his hip and grafting onto the effected vertibrae. It didn't take because of his vascorestrictive effects of the nicotine and carbon monoxide intake. They told him to quit. He did not. Because of the intense pain he was experiencing, they did the surgery three more times over several years, and every time, there were complications because of the effects of his smoking. Finally, after all that, they installed a device that helped keep blood flow in place and it finally took, but by then the damage had been done. There is no way in h**l you can convince me that smoking is worth the pain I saw that man go through. If you need to quit then quit messing around and do it already....sheesh. But whether you do or don't, you have to take responsibility for your own health and not blame others if your bad habits kill you.

    December 6, 2011 at 16:05 | Report abuse | Reply
  29. S. Brown

    Smokers are in denial about the damage smoking causes.

    December 6, 2011 at 18:24 | Report abuse | Reply
  30. Bdayhat


    December 6, 2011 at 18:41 | Report abuse | Reply
  31. MedStudent

    wow, if you would rather have leaches sucking your blood than quit smoking, you've got problems.

    December 6, 2011 at 18:49 | Report abuse | Reply
  32. Sagebrush Shorty

    Cancer cures smoking.

    December 6, 2011 at 19:15 | Report abuse | Reply
  33. erich2112x

    Now you're just being silly, Youn.

    December 6, 2011 at 19:57 | Report abuse | Reply
  34. purple grandaddy

    wow. CNN is as bad as yahoo with their crappy alleged new stories

    December 6, 2011 at 20:12 | Report abuse | Reply
  35. annabucks

    smoking must have cut off blood flow to her brain too

    December 6, 2011 at 21:27 | Report abuse | Reply
  36. jj

    ...so that's what caused it!

    December 6, 2011 at 22:50 | Report abuse | Reply
  37. bilal usman

    i have been smoking for round about 3 to 4 years and one pack daily and today i realized it as i m biological student these are all fact and cigartes are injurious to health but i will minimize my smoking trying level best and want to know that is smoking dangerous for my studies?

    December 6, 2011 at 23:12 | Report abuse | Reply
  38. larry5

    You're kidding me. You say people really suck on burning leaves, suck the smoke into their lungs and pay for the privileged? And we pay for all the trash they leave behind, on the streets, in the parks and on the sidewalk?

    December 7, 2011 at 01:30 | Report abuse | Reply
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    December 11, 2011 at 22:08 | Report abuse | Reply
  41. Joy B

    I am a nurse in the recovery room. A majority of what we do is cosmetic and reconstructive breast surgery. I have seen this happen on many occasions/ We have 2 groups of surgeons who test for nicotine in the urine (yes there is a test) prior to surgery and I have seen them refuse to do the case if the patient tests positive. I have seen a lot of women walk out angry without their new breasts but it is the MD on the line too not just the patient. Second hand smoke can cause the same problem too.

    December 12, 2011 at 08:04 | Report abuse | Reply
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    Really??? I'd guess that this 'warning' would scare people away from using this MD for much of anything-I find this a bit blown out of proportion.

    December 26, 2011 at 17:57 | Report abuse | Reply
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