Immediate or delayed contralateral symmetrisation in therapeutic mammoplasty-A systematic review

For patients undergoing unilateral therapeutic mammoplasty for breast cancer, the timing of contralateral symmetrisation to achieve optimal outcomes is unclear. This review aims to evaluate studies examining outcomes following immediate or delayed symmetrisation.

A literature search of four databases (MEDLINE, EMBASE, Web of Science and Scopus) yielded 1077 papers. Thirty-five articles encompassing 2297 patients met the inclusion criteria for systematic review. The primary outcome was patient reported outcome measures (PROMs) and secondary outcomes included cosmesis, cost-effectiveness and complications.

Two studies directly compared immediate and delayed contralateral symmetrisation, 17 studies focused only on immediate and six on delayed symmetrisation. PROMs were reported in 13 immediate symmetrisation studies describing high-levels of patient satisfaction (range of satisfaction with breasts = 68.6-81.5). Cosmesis was reported in 13 immediate and two delayed studies. Delayed symmetrisation was associated with inferior results (50 % described "unfair" outcomes in delayed studies vs. 89 % "fair", "good" or excellent" cosmetic outcomes in immediate studies). Complications across 34 studies were similar regardless of whether symmetrisation was immediate or delayed. Cost-effectiveness was reported in one study and observed significantly greater costs associated with delayed procedures [median (range) costs: immediate = €4696 (€2724-6745); delayed = €9368 (€6982-11 646)].

High levels of patient satisfaction are reported with immediate symmetrisation, but comparisons with delayed mammoplasty is lacking. Patients receiving immediate symmetrisation report superior cosmesis and financial outcomes, with no additional increase in complications. Further research is required to directly compare PROMs and aesthetic outcomes of immediate and delayed symmetrisation.