Importance of residency/fellowship prestige

Current M4, going into orthopedics and on the interview trail right now -- taking a little bit of a break over the holidays and was hoping I could get some opinions on this.

What is the overall importance of residency & fellowship 'prestige' on future job prospects? Obviously if you want to be an academic orthopod at the Mayo Clinic, HSS, Harvard, etc... then going to a powerhouse residency and fellowship is probably the right choice. I'm more questioning the other positions -- either smaller academic programs, or non-academic hospitals/private practice? How about if you want to move to a different region after residency? Say you train at a smaller program in the midwest -- is it still feasible to compete for jobs out west or the north-east if you ultimately decide you'd like to go there?

Slightly related question -- does where you went to residency effect your fellowship options? I know this obviously plays a part; however, I've found on the trail this year that many applicants are coming from low to mid tier medical schools, but are pulling top-tier interviews due to a quality application (good step 1, AOA, research, etc..), even if their home program/faculty aren't incredibly well known. Is this possible with residency, to "move-up a tier" so to say, if you are a great resident, publish frequently, etc?

I ask because I've gotten competing advice from residents and faculty ahead me. Some are of the opinion that you should go to the "best" (aka, biggest name) residency possible, while others think you should go to the one you fit in with best. I just so happen to find myself fitting in better at the smaller programs -- but I feel like the devil is on my other shoulder echoing the words of those faculty and residents saying that I should try and go to the big name academic programs.

I wanted to post this and ask because I know from talking with many other applicants that they have the same concerns and questions, and I haven't found it answered well here or orthogate.

Thanks for any advice.

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Importance of residency/fellowship prestige