Who can have breast surgery and who should not? Candidates, contraindications and expectations

Almost every page about this surgery is written so that the answer is yes. This one assumes from the outset that sometimes the right answer is “no” and sometimes it is “not yet”, and explains when.

Not out of caution: because a badly selected candidate is the most frequent cause of a result that does not convince, and that costs a second operation that could have been avoided.

The starting requirements

Being 18 and fully developed

From 18 years of age and once breast development is complete. Below that age, breast surgery is only considered for specific clinical situations — malformations, severe asymmetry — and never for purely aesthetic reasons.

And at the other end there is no upper age limit: what is assessed is your state of health, not the number. It is set out in the page on the age for surgery.

Being in good health

As with any surgery under general anaesthetic. What gets checked — blood tests, medication, medical history — is in the pre-operative page.

Having expectations the surgery can meet

It is the requirement examined least and the one that weighs most. It comes back at the end of this page.

What really decides: the tissue you have

Here is the part that surprises a lot of people.

The volume that can be placed is not decided by what you want or by what you have seen in a photograph: it is decided by what is there. Specifically:

• The width of your breast base. An implant wider than your own breast looks like exactly that.
• The thickness and elasticity of your skin. Thin skin covers less well, and thins further over time.
• How much of your own tissue there is for cover. It is what separates a natural result from one where the implant shows, can be felt and shows at the edges.
• The position of the nipple relative to the inframammary fold, which is what says whether lifting is needed as well as augmenting.
• The starting asymmetry and the shape of the chest wall. Practically no breast is symmetrical, and surgery improves that, it does not even it out.

🔑 Putting in more volume than the tissue allows is not an aesthetic preference: it raises the risk. It increases palpability, rippling, visibility of the edges and atrophy of the covering tissue over time — all of them complications the FDA places above 1%.

How the size is chosen within that margin is in the guide to choosing the right size.

When the answer is “this is not the right operation”

These situations do not rule surgery out: they change the operation. And confusing them is the commonest cause of an unsatisfactory result.

A sagging breast

If the nipple has dropped below the inframammary fold, the problem is not one of volume but of position. An implant adds volume to something that is sagging; it does not lift it.

The solution may be a lift (mastopexy), alone or combined with an implant. Which one suits each case is in the comparison between mastopexy and simple augmentation.

⚠️ It is the cluster’s number one confusion. Anyone asking for “just implants” on a drooping breast usually ends up needing the lift afterwards.

Tuberous breast

A tuberous breast has a narrow base, a high fold and often an expanded areola. It is not a small breast: it is a malformation of breast development, and placing an implant without correcting the base reproduces the deformity at a larger size.

It is recognised, classified and operated on differently. It is in the tuberous breast page and in how to tell whether you have them.

An emptied breast after pregnancy or weight loss

Here volume genuinely is missing, but often support is missing as well. If the skin has stretched, an implant alone may not be enough. It is assessed the same way as a sagging breast.

When the answer is “not yet”

If your weight is not stable

The breast is, to a large extent, fatty tissue. A weight that is going to go down or up significantly is going to change the result — and if the loss is substantial, it can add laxity that was not there before.

The practice’s criterion is at least 3 months of stable weight before surgery.

⚠️ It is especially relevant today with pharmacological weight-loss treatments: if you are in the middle of a process, the sensible thing is to finish and stabilise first. And if you are taking one, it has to be mentioned at the pre-operative consultation, because it affects the preparation for anaesthesia — it is explained in the pre-operative page.

If a pregnancy or breastfeeding is imminent or recent

It does not rule surgery out, and in fact most women with implants can breastfeed. But the breast changes during pregnancy and breastfeeding, and often ends up different afterwards.

If you are planning to have children, say so at the first consultation: it shapes the technique proposed, and in particular the incision. It is in the page on breast augmentation and motherhood.

And if you have just finished breastfeeding, we wait for the breast to settle.

If you smoke

Smoking is not an absolute bar, and it is a factor that weighs. The FDA names it expressly among the causes of breast tissue necrosis, along with infection, steroids in the surgical pocket, chemotherapy and radiotherapy.

The period asked for here is a month before and a month after surgery. It is not a round number for convenience: that margin is what optimises how the wounds and scars heal and what reduces the risk of complications. Stopping the night before achieves nothing.

If the moment in your life is wrong

Elective surgery in the middle of a bereavement, a recent separation or a personal crisis is not a medical contraindication, but it is a bad date. The surgery is not going anywhere and a month’s difference does not change the result.

When the answer should be “no”

Two situations are worth being explicit about.

When it is expected to resolve something it does not resolve

A breast augmentation changes the volume of the breast. It does not change a relationship, it does not change a job, it does not change how you feel about yourself in general — it can contribute, and that is not the same thing.

⚠️ When someone arrives convinced that surgery is going to resolve a distress that is not in their breast, operating does them no favours, because the distress is still there afterwards and they have been through theatre as well.

When concern about appearance is disproportionate

There is a clinical condition, body dysmorphic disorder, in which concern about a minimal or non-existent defect takes up a disproportionate space in a person’s life. It is more frequent among those seeking cosmetic surgery than in the general population, and surgery does not improve it.

⚠️ It is not a judgement or a diagnosis that can be made by reading a web page. It is mentioned because it is part of what a surgeon assesses, and because anyone who recognises themselves in that description deserves to know beforehand.

What is done here when that suspicion arises: recommending psychological support. It is not a formality to get rid of the case or a condition for anything: it is that the problem bringing the person to the consultation is not in their breast, and surgery is not going to resolve it.

And the medical contraindications proper

They are those of any surgery with an implant: active infection anywhere, serious uncontrolled illness, anything preventing a safe general anaesthetic, and a breast cancer under investigation or treatment without an oncology plan that allows for it — which is a different situation and is in the page on implants after breast cancer.

🔑 And that is also the list the practice applies: there is no separate in-house list. The exact criteria, with your history in front of us, are established at the assessment.

What an implant does not do

Even if you are a good candidate:

• It does not lift a sagging breast.
• It does not fully even out two different breasts. It improves them; the asymmetry is reduced, not eliminated.
• It does not stop the breast ageing. Your own tissue carries on its course around the implant.
• It is not for life. The FDA is explicit: implants are not lifetime devices, and the longer they are in place the greater the likelihood of needing further surgery. It is in the page on how often they are changed.
• It does not guarantee a specific result. Medicine is an obligation of means.

Frequently asked questions

Am I too young or too old?

The lower limit is firm: 18 years of age and breast development complete. The upper one does not exist as a number; your state of health is what is assessed.

My breast is a little saggy. Will implants do?

It depends on where the nipple sits relative to the inframammary fold. If it has dropped below it, an implant adds volume but does not lift, and the result does not usually convince. There a lift is considered, alone or combined with an implant.

One breast is bigger than the other. Can they be evened out?

They can be much improved, and it is worth knowing that practically no breast is symmetrical and that the aim is to reduce the difference, not to eliminate it. In some cases implants of different volumes are used on each side.

I am losing weight. Should I wait?

Yes, the sensible thing is to stabilise first. The breast is largely fatty tissue and changes with weight; and a substantial loss can add laxity that changes the plan.

I smoke. Can I have surgery?

It is not an absolute bar, but it is a factor that weighs: the FDA names smoking among the causes of breast tissue necrosis. The abstinence period asked for is set at the consultation.

I want to have children. Should I have surgery before or after?

It can be done beforehand, and in most cases breastfeeding afterwards is possible. What matters is saying so at the first consultation, because it shapes the technique — especially the incision — and the expectations about how the breast will look afterwards.

Will they tell me no if my case is not suitable?

They should. A consultation that only says yes is not assessing, it is selling. Someone explaining why your case calls for a different operation, or why waiting is advisable, is the sign that you are genuinely being assessed.

Sources

• Risks and Complications of Breast Implants. U.S. Food and Drug Administration, updated 14 December 2023. fda.gov. — Smoking among the causes of breast tissue necrosis, along with infection, the use of steroids in the surgical pocket and chemotherapy or radiotherapy; implants are not lifetime devices and the longer they are in place the greater the likelihood of developing complications requiring further surgery; palpability, visibility, rippling and breast tissue atrophy among the complications occurring in at least 1% of patients.
• Alderman AK, et al. Understanding the effect of breast augmentation on quality of life: prospective analysis using the BREAST-Q. Plastic and Reconstructive Surgery, 2014. PMID 24675184. — 611 submuscular augmentation patients assessed before surgery and at 6 weeks and 6 months: significant improvements in satisfaction with the breast and in psychosocial and sexual well-being, with very large effect sizes; satisfaction with the breast and with the surgical experience was significantly lower in older patients.

Book your consultation

If you have got this far without being clear which group you are in, that is the right conclusion: it is not decided by reading. At the assessment consultation in Valencia the tissues are measured, the position of the nipple and the shape of the breast base are examined, and from that comes a concrete answer — including the answer to wait, or that the operation you need is a different one.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503