Introduction: With the rise in childhood obesity, an increase in the number of patients seeking adolescent breast reduction has been appreciated. This study examines our experience with presenting symptoms, techniques, and both surgical and pathologic outcomes for reduction mammaplasty in the adolescent population. Methods: Medical records of 76 consecutive patients under 18 years of age who underwent reduction mammaplasty over a 10 year period were identified and reviewed for BMI, symptoms, comorbidities, cancer history, surgical technique, resection weight, pathologic findings, and complications. Pathology costs were determined from billing records. Results: Operative indications included neck, back, and/or shoulder pain (75%), intertrigo (8%), shoulder grooving (17%), difficulty finding bras (8%) and participating in sports (9%), and social distress (24%). Average BMI was 31 kg/m2 and 65% of children were obese (BMI > 30). Surgical techniques included Wise pattern (93%) and superior pedicle (7%). Complications occurred in 8 patients (10.5%). Pathologic examination yielded no cancers with 80% normal or mildly fibrotic and 20% benign histology. Per breast reduction specimen, pathology internal costs and external costs by Medicare data averaged $65 and $118, respectively. Conclusions: Adolescent mammaplasty patients present symptoms mirroring those of the adult population but also exhibit greater obesity, physical strain, social distress, and comorbid psychiatric disorders. Literature reports similar complication rates for adults as we found in our adolescent population. We recommend that surgeons strongly consider reduction mammaplasty in the carefully selected adolescent with macromastia, with realistic expectations and complications in this burgeoning group. Routine pathologic examination, however, is not a cost effective goal. © 2010 Surgical Associates Ltd.