Reduction mammaplasty has been shown to be an effective treatment for symptomatic macromastia. The technique of vertical mammaplasty and its modifications has received much attention for the treatment of breast ptosis and for small to moderate breast reductions, but not for larger breast reductions. A retrospective study was performed on all patients having reduction mammaplsty by a single attending plastic surgeon from 2000 to 2002. All patients had reduction mammaplasty via a modified vertical technique using an inferior/central glandular pedicle or free nipple grafting. A large reduction was arbitrarily designated as 1800 grams or more in aggregate. Thirty-four reductions in 17 patients were identified and included in the study. Patients ranged in age from 21 to 71 years. Follow-up was from three weeks to two years. Total tissue removed per patient ranged from 1817 grams to 4635 grams with 836 grams to 2849 grams removed per breast. All patients had relief of symptoms. Eight patients had delayed wound healing, none required reoperation. No scar revisions were performed. Modified vertical reduction mammaplasty is a safe and effective technique for the treatment of symptomatic macromastia in women requiring larger resections.