Autologous flap-based breast reconstruction has become a cornerstone in achieving optimal aesthetic and functional outcomes following mastectomy. Successful reconstruction relies on precise preoperative planning to ensure adequate vascular supply, flap volume, and symmetry. Virtual three-dimensional (3D) surgical planning, based on Computed Tomography Angiography (CTA), has emerged as a critical tool in optimizing flap design and harvest. It enables visualization of vascular anatomy, including perforators, intramuscular trajectories, and subcutaneous course, aiding meticulous preoperative assessment and intraoperative guidance. Additionally, stereophotogrammetry-based 3D imaging facilitates volumetric analysis, improving in symmetry restoration, particularly in unilateral reconstructions. Recent advancements in augmented reality have further refined surgical workflows by enabling real-time intraoperative visualization of preoperative planning data. At our institution, the Anatomy Projector (Radboudumc, Nijmegen, the Netherlands) has been developed to project virtual surgical plans directly onto the patient’s abdomen, integrating vascular anatomy, perforator locations, flap dimensions, and lymph node distribution. This technique has demonstrated significant reductions in operative time and improved surgical precision. This chapter outlines the creation of a virtual surgical planning and usage of projected augmented reality in DIEP flap breast reconstructions. By integrating advanced imaging and augmented visualization, this approach enhances surgical precision, standardizes outcomes, and optimizes intraoperative decision-making, ultimately improving patient results and procedural reproducibility.