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It is not known whether obesity portends poorer outcomes following reduction mammaplasty in adolescent macromastia patients. We review symptoms in obese and nonobese adolescent macromastia patients and describe early outcomes following reduction mammaplasty. Demographics, operative details, and postoperative follow-up data were collected on 67 patients seen at our institution between 1997 and 2008. Variables were compared using 2-sample t tests or Pearson χ2/Fisher exact tests. Mean age at surgery was 17.1 ± 1.6 years. Mean body mass index was 27.9 ± 4.5 kg/m2, and 32.8% were obese. Thirty-four patients (50.7%) experienced minor complications; 1 patient experienced a major complication. Of patients with complications, obese patients reported a greater number than nonobese patients (P = 0.013). There were no differences in the type of complication or self-reported satisfaction between obese and nonobese patients 34.4 ± 25.7 weeks after surgery. Our findings suggest that reduction mammaplasty is well-tolerated in obese and nonobese adolescents with macromastia and that obesity is not an absolute contraindication to reduction mammaplasty in adolescents.