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Reduction mammaplasty has been shown to be 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 mammaplasties involving less than 1000 g of total tissue resected. To refute this arbitrary policy, the authors set out to examine the effect of reduction mammaplasty in which less than 1000 g of breast tissue was resected on patients' macromastia-related symptoms and macromastia-related quality-of-life factors.All patients were given a custom-designed questionnaire designed to evaluate macromastia-related symptoms and other macromastia-related quality-of-life issues. Patients were then provided the same questionnaire at their final postoperative visit between 3 and 12 months after surgery.A total of 59 patients underwent reduction mammaplasty of less than 1000 g. Reduction mammaplasty less than 1000 g resulted in significant decreases in all macromastia-related symptoms analyzed, including upper back pain, lower back pain, neck pain, arm pain, shoulder pain, hand pain, breast pain, headaches, rashes, and/or itching and painful bra strap grooving (all p < 0.00002). Furthermore, reduction mammaplasty resulted in significant improvement in all quality-of-life factors analyzed, including difficulty buying clothes and bras, difficulty participating in sports, and difficulty running (all p < 0.00001).Reduction mammaplasty totaling less than 1000 g offers substantial relief of macromastia-associated symptoms and results in significant improvement in patients' quality of life. This prospective study conclusively demonstrates that reduction mammaplasty totaling less than 1000 g should be a fully reimbursable procedure.