Immediate versus delayed contralateral symmetrisation in autologous breast reconstruction: A comparative study

The optimal timing for contralateral breast symmetrisation in autologous breast reconstruction remains a controversial and under-researched topic, even though approximately 50% of patients will undergo contralateral symmetrisation procedures at some point in their reconstructive journey.

We conducted a retrospective comparative study including patients who underwent unilateral autologous breast reconstruction with either immediate or delayed contralateral breast symmetrisation from January 2018 to December 2022 at the Queen Victoria Hospital. Data were collected on patient age, timing of breast reconstruction and symmetrisation, flap type, operative time of the reconstructive procedure, length of hospital stay, complications requiring return-to-theatre, total number of surgical procedures and length of the reconstructive journey.

Overall, 417 patients were divided into two groups based on the timing of contralateral symmetrisation (Group 1: 299 patients with delayed symmetrisation and Group 2: 118 patients with immediate symmetrisation). The two groups were comparable in terms of age and surgical characteristics. Although immediate symmetrisation significantly increased the operative time of the reconstructive procedure, there was no increase in the rate of complications requiring return-to-theatre or in the length of hospital stay. Patients who underwent immediate symmetrisation had a significantly lower total number of surgical procedures with a shorter reconstructive journey.

Our study showed that immediate contralateral breast symmetrisation is safe, reduces the total number of surgical procedures and shortens the reconstructive journey for patients undergoing unilateral autologous breast reconstruction.