The symmetry of quantum theory under time reversal has long been a subject of controversy because the transition probabilities given by Borns rule do not apply backward in time. Here, we resolve this problem within a rigorous operational probabilistic framework. We argue that reconciling time reversal with the probabilistic rules of the theory requires a notion of operation that permits realizations via both pre- and post-selection. We develop the generalized formulation of quantum theory that stems from this approach and give a precise definition of time-reversal symmetry, emphasizing a previously overlooked distinction between states and effects. We prove an analogue of Wigners theorem, which characterizes all allowed symmetry transformations in this operationally time-symmetric quantum theory. Remarkably, we find larger classes of symmetry transformations than those assumed before. This suggests a possible direction for search of extensions of known physics.