Patients with increased body mass index (BMI) are often denied reduction mammoplasty due to concern for high morbidity. There is a paucity of evidence identifying high BMI as a predictor of poor long-term outcomes in reduction mammoplasty. In this study, we investigated the influence of BMI on long-term patient satisfaction following reduction mammoplasty.All patients undergoing reduction mammoplasty over a 12-year period at a single institution were included in the study. A retrospective chart review was conducted to extract demographics, operative data, and postoperative course including complications. Patients were classified into 4 categories based on BMI (normal (<25), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40)). Patient satisfaction was assessed using a customized survey which was administered over the phone. Only patients with complete medical records who participated in the survey were included.The 70 patients met the inclusion criteria for the study. Median time from surgery to survey was 6 years. Overall satisfaction after reduction mammoplasty was high, 5 on a 5-point Likert scale. The amount of breast tissue resected correlated with patient BMI (P <.01). There was no statistical difference in satisfaction across BMI classes. Furthermore, high BMI (obese, and morbidly obese) was not associated with higher postoperative complications (P = .70). Those with a high overall satisfaction score had a significantly greater self-reported aesthetic score compared to those with low and mid satisfied scores (P <.01).Following reduction mammoplasty, patients report high satisfaction which is sustained over several years. Obesity is not associated with a higher incidence of complications or lower satisfaction. Our data suggest that patients with a high BMI should not be denied reduction mammoplasty out of concern for higher complication rate or reduced patient satisfaction due to BMI alone, but reduction mammoplasty should be considered in the setting of overall health counseling.