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CT angiogram (CTA) is widely believed to improve operative time and flap outcomes for perforator flap breast reconstruction, but the quality of the evidence is not known. We conducted a systematic review of the efficacy of preoperative CTA for abdominal perforator flap breast reconstruction.Inclusion criteria included published articles in English, CTA group, and control group, between 2000 and March 2013. Medline and PubMed were queried. Study quality criteria were developed based on standards of internal and external validity. One reviewer screened titles and abstracts. Two authors independently reviewed the full-text articles. Outcomes of interest were operative time and flap outcomes.Ten publications met inclusion criteria. Study designs included retrospective or mixed prospective-retrospective cohorts. In every study, the control group time period preceded the CTA group time period and no studies adjusted for improved surgical skill (i.e., learning curve effect). Sample sizes ranged from 41 to 357. Five studies did not perform or provide statistical analysis for the results presented. The mean quality rating was 2.8 (out of a maximum of 7). Seven of 10 studies found a shorter operative time with CTA. Two of nine studies found fewer partial flap failures with CTA.CTA is associated with shorter operative time, but some of this may be due to a learning curve effect. The evidence does not show a difference in flap outcomes. The evidence in support of preoperative CTA is limited and subject to bias due to study design.