BACKGROUND: Free abdominal flaps are the first option in autologous breast reconstruction using the multidetector-row computed tomographic angiography for mapping the abdominal perforators. The authors aim to evaluate the impact of using a preoperative design for shaping the new breast symmetrical to the contralateral breast, assisted by multidetector-row computed tomographic angiography.METHODS: Thirty-two consecutive patients who underwent delayed unilateral breast reconstruction with free abdominal flaps were divided into two groups. In group A, the new breast was shaped intraoperatively and inset, whereas in group B, a preoperative design of the new breast was used. All patients underwent multidetector-row computed tomographic angiography before the operation and the flaps were centralized around the selected perforators. Both groups were evaluated for the time spent on flap harvest, time spent on breast shaping and inset, complication rates, and secondary operations required for breast symmetrization. Independent surgeons evaluated the final aesthetic outcome.RESULTS: The mean time spent on harvesting the flap was not significantly different between the two groups (p > 0.05); the mean time spent on breast shaping and inset was significantly shorter in group B (p < 0.001). There were no differences between the two groups regarding complications recorded, whereas symmetrization surgery was significantly less in group B (p < 0.05). At a mean follow-up 17.3 months, the final aesthetic outcome was greater in group B.CONCLUSION: Predesigned breast shaping assisted by multidetector-row computed tomographic angiography promotes a significant reduction in the overall operative time and the need for secondary symmetrization procedures.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.