Of women who seek reduction mammaplasty, up to a third have pathological degrees of anxiety or depression, or both. The psychological aspect of reduction mammaplasty is therefore an important consideration. We did a prospective randomised clinical trial to see how reduction mammaplasty affected macromastia patients' depression, anxiety, and self-esteem. Eighty-two patients were randomised, 40 to have the operation, and 42 patients to conservative treatment. Both groups were followed for six months. The patients completed the RBDI questionnaire (Raitasalo's modification of the short form of the Beck Depression Inventory). Twenty-nine patients in the operated group and 35 patients in the conservative group completed the study. At the second examination, the patients who had been operated on, had significantly less depression (p<0.01) and better self-esteem (p=0.03) than the conservative group. The proportions of depressed (p<0.01) and anxious (p=0.04) patients were also smaller in the group who were operated on. There is significantly less depression and anxiety after reduction mammaplasty, and patients' self-esteem is restored.