Introduction: Contralateral symmetrising reduction mammoplasty can be performed at index breast cancer surgery, or as a delayed procedure. Patients have recent diagnostic imaging or ongoing imaging surveillance. Many are also on systemic treatment. At present these mammoplasty specimens are sent for histopathology. Current literature states the incidence of cancer in cosmetic reduction mammoplasty is 0.23% (0-2.8%), presence of atypical lesions is 0.8% (0.3-5%). This study reports on outcomes and cost implications of histopathological analysis for symmetrising reduction mammoplasty.