Objective To explore different techniques for bilateral symmetry in breast reconstruction with implant after tissue expansion. Methods From June 2006 to June 2014, 48 patients received breast reconstruction with implant after tissue expansion. The following symmetrization procedures were used during breast reconstruction. (1) Expander was chosen according to controlateral size and was placed 2 to 3 cm lower than controlateral IMF and then over-expand. (2) The implant was chosen according to the expander, the sizer or the data from 3D photography. (3) Ipsolateral fat transfer, latissimus dorsi muscle flap transplantation, NAC transposition, and contralateral breast reduction, mastopexy, augmentation were used for symmetrization. Results All the patients were followed up for 6 to 48 months, mean 11.9 months. Bilateral symmetry were achieved through these procedures and all patients were satisfied with the results. Conclusion Accurate measurement of the breast, the appropriate choice of the expander and implant, and symmetrization procedures of both side are necessary for better symmetry in breast reconstruction.