From I know you only can lose symmetry from things as hidden geometry as it will not be affected by symmetry or any modification. Also some tools as trim rect doesn’t accept symmetry. The symmetry key is also easy to hit accidentally (I have removed it). There is a indication in the brush cursor when symmetry is active, a double external ring, but I keep missing this.
Then from point of view of general editing apart of these problems I don’t see too much trouble with symmetry. What it is a problem is zmodeler. Even when working with symmetry on eventually will start to give symmetry errors and being unable to complete operations because that. I can not point exactly when the problem appears but the only solution is smartsync in deformation or mirror and weld.
Smartsync is generally the best solution as it won’t modify topology and works most of the time. Unless somebody has better info about this. Masking specific areas would allow smartsync to sync only specific areas or impose one side to the other as otherwise only will do a blend between both sides.
One annoying problem is when the vertical central line is deformed and unaligned. There is a script to correct this.