Macromastia is frequently a potentially debilitating condition leading to the development of clinically significant chronic neck and back pain, bra strap grooving and recurrent intertriginous infections. Such physical findings can be even more pronounced in women who suffer from extremely large volume breast hypertrophy. This group of patients can often be challenging for plastic surgeons in terms of patient selection, surgical approach and fulfilling the patient’s post-operative expectations of functional improvement as well as cosmetically acceptable results. The latter can be further compromised by the post-op scarring of the standard inverted T incisions. This can be even more problematic in patients with pigmented skin. The goal of this clinical study is to evaluate the safety, functional outcome and patient satisfaction of large volume breast reductions (>1000 grams) performed in large urban residency training center. A retrospective chart review was performed on 150 female patients who underwent an inverted T reduction mammoplasty performed during the period from March 1997 to Jan 2001. We will report demographic data as well as post-op outcomes including surgical morbidity, post-op scarring and symptomatic relief. In conclusion, large volume breast reductions are associated with minimal morbidity, alleviation of symptoms, acceptable scarring and patient satisfaction.