According to plastic surgeon Anthony Youn, "smokers who undergo breast lifts are at great risk of losing their nipples." This is not just a theory. Their nipples may "turn black and fall off." I can't imagine a more horrifying scene:
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. [...] I've seen it before.
He had that problem with one of his patients, who ignored his warnings. The nipples started to turn black, full of venous blood. Venous blood doesn't have oxygen and it is full of toxins. If it accumulates in any area of the body, it makes impossible for the cells to survive after a long period of time. This causes necrosis: the tissue dies making nipple fall off.
Fortunately, he fixed it using leeches:
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.
That's not the only horror that smoking can cause to plastic surgery patients. Youn says that "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."
Youn's book seems to be full of quite disgusting but entertaining anecdotes and dialogs. Like:
"Fuck. Her nipples are congested. Let's get some of these stitches out. We're looking for the nipples to turn pink."