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Purpose The purpose of this study was to evaluate the accuracy of virtual planning using customized surgical devices (VP3D) in fibula free flap mandibular reconstruction. Methods Fourteen patients received VP3D and 16 patients underwent conventional surgery (CS). Virtual planning was compared to postoperative scans using cephalometric and three-dimensional (3D) measurements. Operative times of both VP3D and CS groups were compared. Results Comparisons of cephalometric measurements revealed no significant difference between virtual planning and postoperative scans. 3D analysis demonstrated a high level of virtual planning accuracy. In the VP3D group, total operative time gain was 88 min ( p  < 0.001) and total ischemia time gain was 36 min ( p  = 0.04). Conclusion Virtual surgical planning using customized devices enables ‘tailored’ surgery that is accurate and reliable and results in operative and ischemia time gain. Clinical trial NCT03869723.