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The purpose of this prospective study was to determine whether the beneficial effects of reduction mammaplasty are maintained over the long term in a Canadian population and to determine whether reduction mammaplasty facilitates weight loss in the overweight patient.The Short Form-36, Rosenberg Self-Esteem Scale, and Symptom Inventory Questionnaire were used to assess 57 patients preoperatively and postoperatively at 6 months and 21.5 months. Surgeons completed preoperative, operative, and postoperative patient assessment forms to collect anthropometric, procedural, and postoperative complication data.Stable and significant improvements were found in all three outcomes questionnaires when compared preoperatively and 6 and 21.5 months postoperatively. The Short Form-36 indicated significant improvements (p < 0.05) in seven of the eight health status domains and the physical summary score, suggesting that the procedure primarily benefits physical aspects of health. Scores also improved on the Rosenberg Self-Esteem Scale (p < 0.0001) and symptoms improved on the Symptom Inventory Questionnaire (p < 0.0001) in patients 6 and 21.5 months after reduction mammaplasty. The patients had significant health deficits preoperatively compared with the normal population. Preoperative mean Short Form-36 scores were significantly lower in several areas (p < 0.005). The health deficits were eliminated at 6 months and showed a normalization effect at 21.5 months. Patients with a body mass index greater than 27 kg/m2 (n = 26; 1 kg = 2.2 lbs.) showed a significant decrease in weight and body mass index at long-term follow-up at 21.5 months postoperatively (p < 0.003).The long-term results of reduction mammaplasty indicate that this procedure is an effective method to reduce or alleviate both physical and psychological symptoms associated with macromastia. This study shows that this procedure should be covered under Canadian medical insurance plans.