Abstract: reduction weights which achieve both relief of symptoms and excellent shape and size breasts remains a challenge and, in addition, in the selection of patients with symptomatic macromatia for being treated by reduction mammaplasty the estimation of the amount of tissue to be removed plays an important role because this criterion is required almost universally. The objective of this study is to calculate a formula for the preoperative prediction of the amount of breast tissue which has to be removed in the treatment of symptomatic macromastia based on data obtained from a series of patients with symptomatic breast hypertrophy treated with reduction mammaplasty characterized by the fact that successful outcome (functional and cosmetic) had previously been achieved and assessed objectively. Methods A prospective study was performed on 39 patients undergoing reduction mammaplasty for breast hypertrophy. The Short Form (SF)-36 quality of life questionnaire (Spanish version 1.4, June 1999) and the Breast Reduction Assessed Severity Scale Questionnaire, which was double-blind translated, were both answered preoperatively, a week before, and postoperatively, 6 months after surgery, for testing the effectiveness of the treatment. The patients were asked to score cosmetic results (1 to 10, very bad to excellent) and how satisfied with the new breast size they were. Data were collected from these patients to calculate a formula for preoperative prediction of breast resection weight. Regression analysis was performed separately on each of 78 breasts of these patients with breast weight as dependent variable and sternal notch-to-nipple distance (SNN), inframammary fold-to-nipple distance (IMFN), age, body mass index (BMI) and ascent of the nipple areola complex (ANAC) as independent variables. Results A simple model combining two variables (IMFN, ANAC) is strongly correlated with actual resection weight with adjusted r2 coefficient of 0.701. The formula breast weight (g)=(60(ANAC) (cm)+50(IMFN) (cm))-648 can predict resection weight which obtains satisfactory cosmetic results and a relief of symptoms improving quality of life. Conclusions A new easy formula to estimate preoperatively the amount of breast tissue to be removed is offered to surgeons who are planning a breast reduction mammaplasty. Level of evidence: level IV, risk/prognostic study

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