PURPOSE: Literally dozens of studies have shown that reduction mammoplasty (RM) is efficacious in reducing the burden of symptoms and improving the quality of life for patients with macromastia. However, most insurance carriers will not reimburse for mammoplasty involving less than 1000g total tissue resected. In order to assess the validity of this arbitrary policy we set out to examine whether patients' pre-operative symptoms as well as the amount of post-operative improvement were correlated with the amount of tissue resected. METHODS: All patients were given a custom designed questionnaire designed to evaluate the patients' macromastia-related symptoms and other macromastia-related quality of life issues. Patients were then provided the same questionnaire at their final post-operative visit between three and twelve months after surgery. Patients were stratified according to the total amount of tissue resected (Group <1000g [Avg: 826g], 1000-1500g [Avg: 1184g], 1501-2000g [Avg: 1715g], >2000g [2272g]) and their responses analyzed using an ANOVA across the groups. RESULTS: A total of 188 patients who underwent RM (by a single surgeon, NK) completed both the pre-op and post-op questionnaires. ANOVA across groups demonstrated significant differences in only three pre-operative measures: lower back pain, shoulder pain and painful bra straps and grooves (p<0.05). There were no significant differences in several pre-op measures such as upper back pain, neck pain, arm pain, shoulder or hand pain, headaches, breast pain, difficulty finding clothes and bras, rashes and itching, difficulty running and doing sports. ANOVA across groups <2000g revealed a significant difference only in pre-operative painful bra straps and grooves (p<0.05). Furthermore, ANOVA across all groups assessing the change between pre-op and post-operative symptoms demonstrated no significant differences with the exception of shoulder pain (p<0.05). CONCLUSION: This prospective, longitudinal study provides the first analysis of outcomes from RM stratified by the amount of tissue resected. These data indicate that patients' pre-operative symptoms are not statistically different across a wide range of tissue weights resected. Furthermore, our data demonstrate that the improvement experienced by patients undergoing RM is largely not statistically different over a wide range of resection weights. These data conclusively demonstrate the widely held impression of many plastic surgeons that macromastia is not a term that can be defined by a number but rather needs to be considered within the context of the individual patient.