The quality of a breast reconstruction is gauged by the symmetry achieved when the reconstructed and opposite breasts are compared. In order to produce a symmetrical appearance, it is often necessary to revise the contralateral, previously unoperated breast. A procedure on the opposite breast can be performed at the same time as breast reconstruction or can be delayed for several months. The purpose of this study was to compare the simultaneous TRAM flap and contralateral breast reduction/mastopexy with the TRAM flap alone according to selected parameters. Our results suggest that performing the combined procedure is safe and yields a satisfactory aesthetic result.