BACKGROUND: Symptomatic mammary hypertrophy impacts physical function and patient quality of life. Breast reduction mammoplasty, a surgical procedure performed to reduce breast size, has been used for many years to reduce these symptoms. OBJECTIVE: To evaluate variations in the surgical practice of breast reduction mammoplasty among women >15 years of age (approximately 6.4 million population in 2008) over a 17-year period in Ontario.