Immediate versus delayed symmetrisation of the contralateral breast after oncoplastic procedures: A systematic review and meta-analysis.

Abstract

The optimal timing of contralateral symmetrisation in oncoplastic breast surgery remains controversial. The aim was to compare outcomes between patients who underwent immediate versus delayed symmetrising procedures. A systematic review was performed in accordance with the PRIMSA guidelines. PubMed, Embase and Scopus databases were searched for studies reporting outcomes of oncoplastic procedures with immediate and delayed contralateral symmetrisation. Meta-analyses were conducted for surgical, oncological and patient-reported outcomes between the two groups. Twelve studies comprising 2339 (immediate, n = 1227 and delayed, n = 1112) patients were included. There were no significant differences in overall complications, all reoperations, reoperations for complications, aesthetic revisions, recurrence rates, delays in adjuvant therapy or patient-reported outcomes between the two groups. In the subgroup of patients who underwent breast conserving surgery, immediate symmetrisation was associated with lower rates of overall reoperations (19.3% vs 25%, p = 0.03), reoperations for complications (5.2% vs 10.9%, p = 0.01) and aesthetic revisions (6.6% v 15.2%, p = 0.0003). Delayed symmetrisation trended towards lower rates of aesthetic revisions in the mastectomy cohort (18% vs 28%, p = 0.002). Immediate contralateral symmetrisation does not appear to increase oncologic risk and provides comparable overall outcomes to delayed procedures. In the setting of therapeutic mammaplasty, immediate symmetrisation may reduce the need for secondary procedures, thereby supporting its use in appropriately selected patients. These findings can help guide multidisciplinary decision-making and inform patient counselling regarding the timing of contralateral procedures in oncoplastic breast surgery, but it should be interpreted in the context of predominantly retrospective data and moderate heterogeneity.