Introduction: Obtaining symmetric breast reconstruction is facilitated with the knowledge of pre-mastectomy and post-reconstruction volume. The purpose of this study is to determine the benefit of 3-dimensional digital photography in assessing breast volume and as a means to facilitate obtaining symmetry in breast reconstruction using the free TRAM and DIEP flap. Methods: Premastectomy volume is calculated using the Rainbow 3-dimensional camera (Genex Technologies, Kensington, MD). This computer-linked camera operates via patient illumination with structured light, analysis of wavelength alteration from the reflected light, and creation of a 3-dimensional photographic image. Premastectomy volume was measured on 14 women prior to free TRAM reconstruction (8 bilateral and 6 unilateral) and on 5 women prior to DIEP flap reconstruction (1 bilateral and 4 unilateral). Mean age for all women was 46.7 years (range, 25 to 63 years). The timing for reconstruction was immediate in 18 women and delayed in 1 woman in whom the opposite breast was imaged. Mean follow-up for all women was 18 months (range, 12 to 26 months) Results: Mean premastectomy volume of the 22 breasts for free TRAM reconstruction was 512 cc (range, 185-1109cc) and of the 6 breasts for DIEP flap reconstruction was 494 cc (range, 311-753). Unilateral reconstruction was completed in 10 women. Of these, volume symmetry was obtained in 9 women (90%). Volume asymmetry requiring revision was necessary in 1 women and included delayed placement of a 150 cc implant beneath a free TRAM. The implant size was determined based on the calculated volume discrepancy between the two breasts. Bilateral reconstruction was completed in 9 women and resulted in volume symmetry in all. Conclusion: Three-dimensional digital imaging is an excellent tool to assist the surgeon with the preoperative planning of unilateral breast reconstruction. This imaging technique is also useful postoperatively to assist with correcting volume asymmetries.