The safety of simultaneous versus delayed contralateral breast symmetrization: Systematic review and meta-analysis

While unilateral breast reconstruction often requires contralateral breast symmetrization procedures, the optimal timing of the matching procedure remains unclear. While the delayed approach may be traditionally perceived as safer, the immediate or simultaneous approach may reduce additional operations and avoid a period of breast asymmetry. This study investigates and compares the safety outcomes associated with simultaneous and delayed contralateral symmetrization.

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Scopus databases were queried to identify studies reporting safety outcomes in breast reconstruction patients who had received simultaneous and/or delayed contralateral symmetrization. Meta-analyses estimated the pooled complication and reoperation rates of the simultaneous group and compared the complication and reoperation rates between the simultaneous and delayed groups.

Eleven studies with a total of 1263 patients were included, with 697 receiving simultaneous symmetrization and 566 receiving delayed symmetrization. Symmetrization procedures included reduction (36%), mastopexy (28%), augmentation (12%), augmentation-mastopexy (3%), reduction-mastopexy (2%), or unspecified (19%). The reconstruction types included autologous flap-based reconstruction (n = 1038) and implant-based reconstruction (n = 225). The pooled overall complication and reoperation rates of the simultaneous group were 17% and 28%, respectively. In studies comparing the simultaneous and delayed groups, there were no significant differences in overall complications, hematoma, necrosis, and reoperations (P-values > 0.05).

Simultaneous symmetrization had similar complication and reoperation rates compared to delayed symmetrization. This conclusion supports the relative safety of simultaneous symmetrization in breast reconstruction and gives the surgeon and patient additional data to consider in their shared decision-making process.