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Heavy metals represent a significant hazard in textile wastewater, posing a considerable risk to both the ecosystem and human health. The objective of this study was to analyze the removal efficiency of specific heavy metals in a large wastewater treatment plant (WWTP) located in Prato (Tuscany, Italy), where the main Italian textile district is based. To achieve this, the mass balance calculation approach was employed. Therefore, two monitoring campaigns were conducted, collecting wastewater and sludge samples in some specific sections of the WWTP. The concentrations of Pb, Cd, Ni, As, and Sn were consistently below the detection limits. A good removal efficiency was determined for Zn, Cu, Ba, Crtot, and Sb, in the range of 37–79%. These metals are predominantly present in particulate form, facilitating their removal through sedimentation. Conversely, boron is largely present in the dissolved phase, resulting in its complete release through the treated effluent. Subsequently, an excellent linear correlation was identified between the input load and the contaminant load removed. This demonstrated that the plant's efficiency remains unaffected by an increase in the input load at the observed contaminant concentrations. Finally, a probability law was identified that demonstrates an excellent degree of approximation in representing inlet metal concentrations. The findings of this study indicate that the treatment systems employed by the WWTP are capable of effectively removing heavy metals. [ABSTRACT FROM AUTHOR]