Breast plastic surgery in perimenopausal and postmenopausal women: Menopause-informed counseling on screening, safety, and long-term breast health.

[OBJECTIVES] To synthesize evidence on breast plastic surgery in peri- and postmenopausal women and provide menopause-informed guidance on surgical safety, cancer screening, and long-term implant surveillance.

[STUDY DESIGN] Narrative review of clinical trials, observational cohorts, registries, guideline statements, and high-quality reviews addressing breast augmentation, reduction, mastopexy, and reconstruction in women aged 50 years or more.

[MAIN OUTCOME MEASURES] Perioperative complications, venous thromboembolism, wound-healing and donor-site problems, long-term device outcomes (reoperation, capsular contracture, rupture, breast implant-associated malignancies, breast cancer screening performance, implant integrity surveillance, and patient-reported outcomes.

[RESULTS] Across procedures, chronological age alone is not an independent predictor of major short-term complications; risk is driven primarily by comorbidities (diabetes, obesity, smoking, prior radiation) and by hormone-related changes in skin quality, vascularity, and coagulation. Hypoestrogenic states and certain hormone therapies are associated with modestly higher rates of wound-healing problems and venous thromboembolism, particularly in microsurgical reconstruction, but absolute risks remain acceptable with optimization and prophylaxis. For implant-based surgery, reoperation rates of roughly 20-40% at 10 years reflect capsular contracture, rupture, and aesthetic change, while rare late events such as breast implant-associated anaplastic large-cell lymphoma become increasingly relevant as women age with implants in situ. Implants reduce mammographic sensitivity, necessitating implant-displacement views and individualized imaging strategies that distinguish cancer screening from device surveillance. Despite these complexities, postmenopausal women report high satisfaction and meaningful quality-of-life gains across aesthetic and reconstructive procedures.

[CONCLUSIONS] Breast plastic surgery after menopause is safe and beneficial when comorbidities, frailty, and hormone therapy are thoughtfully managed. Menopause-informed, risk-stratified counseling and coordinated screening and surveillance plans are key to supporting durable, patient-centered breast health in midlife and beyond.