Evaluating the Paucity of Female Surgeons in Plastic Surgery: A Review of the Systemic Barriers to Entry and Success.

The percentage of practicing female plastic surgeons in the United States is notably low. This narrative review sought to identify prominent barriers affecting women's entry and success in plastic surgery. A literature search was conducted using the National Library of Medicine from 2013 to 2023, using MeSH terms of gender disparity and plastic surgery. Included publications were peer-reviewed articles and systematic reviews evaluating gender disparity in plastic surgery, examining experiences, challenges, or opportunities for female plastic surgeons. Excluded publications did not include data gathered from the United States, included other minorities, or did not focus on plastic surgery. Overall, 191 papers were identified, with 14 papers being selected for this review. Early barriers identified before residency training include the lack of female mentors and the underrepresentation of female presenters at national plastic surgery conferences, with females comprising only 29% of presenters and 16% of abstract senior authors at national plastic surgery conferences between 2014 and 2015. During residency training, the most prominent barrier is pregnancy, with 73% of women delaying childbearing during residency and only 39% of men reporting the same. A second barrier during training includes gender disparity in the number of research publications, with females publishing 8.89 ± 0.97 publications during residency and males publishing 12.46 ± 1.08 publications (p = 0.0394). After residency training, evidence of barriers to career advancement includes poor representation of women in higher academic positions, such as program chairs and directors, with female representation of 9.2% and 13.1%, respectively, and gender disparity in industry payments. Systemic barriers before, during, and after plastic surgery residency training seem to influence the representation of women in plastic surgery at all levels. These barriers should be addressed to increase the number of practicing female plastic surgeons and diversify the field.