Southwestern Atlantic reefs are experiencing increased bleaching-associated mortality, prompting the proposal of active coral restoration as a solution. However, this approach faces challenges such as genetic bottlenecks, cost, scale, survival amidst local and global impacts, and long-term efficacy. Thus, we reviewed the major attributes of Southwestern Atlantic reefs and their coral species to assess the feasibility of active coral restoration in this unique biological and oceanographic setting. We also examined existing restoration techniques and their applicability to Southwestern Atlantic coral species and reef sites. Few species meet both suitability and priority criteria for restoration, with only Millepora alcicornis, Mi. braziliensis, and Mi. nitida, and, to a lesser extent, Mussismilia braziliensis emerging as relevant candidates. In this low-diversity region, suitable species are scarce, and identifying suitable restoration sites is challenging due to widespread local impacts and ineffective policy enforcement. We propose that practitioners (i) master species-specific fragmentation, handling, care, and monitoring techniques; (ii) align restoration practices with scientific knowledge; (iii) avoid combining multiple interventionist techniques; (iv) acknowledge potential conflicts of interest in restoration practices; and that (v) government agencies oversee restoration activities, and that transparency reports be generated. Southwestern Atlantic reefs need custom-designed conservation measures, and baseline data is essential for identifying suitable restoration sites. Although few species are viable candidates for restoration, and its effectiveness in restoring degraded reefs is unproven under current climate conditions, following the proposed ethical and ecological guidelines may help sustain threatened species and ecosystem services in degraded areas until climate change policies take effect.