Immediate Symmetrization of the Contralateral Breast in Breast Reconstruction-Revision, Complications, and Satisfaction: A Systematic Review

Background: It is desirable to achieve breast symmetry after unilateral surgery for breast tumors. Thus, contralateral balancing is often required, but it is still debated whether symmetrization surgery should be performed alongside reconstruction or as a delayed procedure. Therefore, we aimed to compare revision rates, complication rates, and satisfaction levels between those who underwent immediate versus delayed symmetrization. Methods: A systematic review was designed to summarize the revision surgery rates, complication rates, and satisfaction levels of patients who underwent contralateral breast symmetrization at the same time as breast reconstruction. We included articles published between 2010 and 2022 in databases such as PubMed, MEDLINE, and Embase. Results: Most studies showed no difference or lower revision rates for immediate symmetrization, except for one study where immediate symmetrization had a revision rate twice that of delayed symmetrization. There were no significant differences in complication rates between the two groups. Regarding satisfaction levels, most studies showed that the immediate group had higher scores regardless of statistical significance; however, breast-related satisfaction was significantly higher in the immediate group than in the delayed group. Conclusion: This systematic review demonstrates that immediate symmetrization surgery does not increase revision surgery and complication rates or decrease satisfaction levels.