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How badly the formatting changes when you reflow depends on how the PDF was made. If it was tagged for accessibility--made to be able to be read by readaloud software for the blind--it reflows better. I don't know if ADE or Adobe Reader will even tell you if a file is tagged.
Most commercial PDFs aren't tagged. Tagging is possible with Acrobat Professional, but not with 3rd party or free software. (Also, not possible to do to DRM'd books; they'd have to be cracked first.)
If you can edit the PDF file, cropping out the white borders is sometimes enough of a change to not need to reflow. But overall... PDF is a lousy ebook format for exactly this reason; it's locked to one page size and doesn't work well on screens that aren't that size.
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