Achieving gender parity: Women's role in plastic surgery

Most plastic surgeons are men, but more women are entering the specialty each year. In 2024, women comprise only 19 percent of membership in the United States for the American Society of Plastic Surgeons (ASPS), but gender parity is coming to plastic surgery. The latest data on residents entering the specialty shows an almost equal number of women and men becoming plastic surgeons – 51 percent male and 47 percent female – which marks a significant change from just three years ago when only 40 percent of plastic surgery residents were women.

While gender has no bearing on skill, expertise or success, research shows diversity in healthcare teams leads to better patient outcomes. Many female patients may be able to relate to a woman physician who looks like them and may have similar life experiences.

"I've been subjected to society's beauty standards," said Kelly Killeen, MD, a board-certified plastic surgeon in Beverly Hills, Calif. "I've had the same insecurities placed on me. There's a familiarity that we have as women."

Women plastic surgeons are also more likely to have had some of the same surgeries their patients seek. San Francisco plastic surgeon Karen Horton, MD, MSc, FACS, FRCSC, for instance, had a mommy makeover. She then created a blog series on her website about her surgery to help other women navigate the procedure.

"We practice what we preach," said Dr. Horton. "We don't just offer it. I think there is really something powerful when a patient tells you that the drain is driving them crazy to be able to say, 'Oh my gosh, it drove me crazy, too.' Having that ability to commiserate in addition to the practical knowledge of being a surgeon is so helpful."

Female plastic surgeons may also offer unique insights into their patients' motivations.

"A female surgeon may know what it's like to have really large breasts and the pain that comes from that," said Kristy Hamilton, MD, a board-certified plastic surgeon in Houston. "We're going to talk about those realities when it comes to implants. A man, by nature of his gender, cannot have experienced that."

Diversity among women in the specialty is also critical because women of color have been largely underrepresented in many areas of society.

"A lot of my patients are ethnic women," said Umbareen Mahmood, MD, a board-certified plastic surgeon in New York. "I think they can really relate to me as an ethnic female. Growing up, I didn't really see a lot of women of color in fashion or in beauty. Now that patients can see themselves represented in before-and-afters is incredible for them."

Seeing more women in plastic surgery is not only good for patients – it's also good for the specialty by encouraging more people of all backgrounds to consider it.

"Diversity in an academic setting is important for our ability to recruit future plastic surgeons who are also similarly diverse," said Lynn Damitz, MD, and chief of the Division of Plastic Surgery at the University of North Carolina School of Medicine. "Trying to make sure we have as diverse an up-and-coming plastic surgery workforce as possible has been a focus of many of us for a long time so that we can learn from different perspectives and, most importantly, best serve our patients with all of their needs."

Up to the challenge: Breaking barriers

Despite this demographic shift, women face many challenges in their journeys to becoming plastic surgeons, including pay parity, sexual harassment and underrepresentation in academics and at conferences. Many were even discouraged from pursuing a surgical specialty after medical school.

"For most of us, we were being told no from the second you say, 'Oh, I'm interested in plastic surgery,'" said Katerina Gallus, MD, FACS, a board-certified plastic surgeon in San Diego.

Just as it is in other professions, equal pay can be an obstacle for women in plastic surgery. Dr. Mahmood recounted a conversation with her brother, a spine surgeon, when she got her first offer to join a private practice after residency.

"I was so excited to finally make money and just not live on cereal every night, so I took the offer without negotiating it," said Dr. Mahmood. "He said men would fight to the penny, and you're just taking what you get."

It was a woman in a leadership role who helped Dr. Damitz equalize her pay.

"She called me into her office and said, 'I want you to be aware that as the only woman professor, you are making less than every man in this department for your level,'" said Dr. Damitz. "It took another woman leader to come in and say, 'I'm noticing that this is inequitable, and we need to fix that.'"

Dr. Damitz now ensures her students understand they can and should negotiate contracts.

Stopping sexual harassment

One of the most nefarious challenges facing women across all professions – including surgeons – is sexual harassment.

A 2019 study in Plastic and Reconstructive Surgery – Global Open found that 20 percent of plastic surgery residents (72 percent of them were women) experienced sexual harassment. In addition, most (74 percent) did not feel comfortable reporting it.

"When I was going through training, the behavior from some male colleagues was just abhorrent," said Dr. Killeen. "It became a situation where if you didn't tolerate it, you were labeled as something. You were 'that' female resident. You were not strong enough, not tough enough."

Identifying and calling out sexual harassment is essential to make women feel more welcome in any workplace. Some recommend preparing a response to inappropriate behavior in advance to keep from struggling to verbalize a response in the moment.

"It's important to address it calmly at the time of the instance and have set phrases that you plan on using," said Dr. Gallus. "Oftentimes, it's just stating facts: 'That joke made me uncomfortable. I would appreciate it if you stopped.' Not: 'That joke was offensive' or 'That joke is misogynistic.' If it goes unchecked or unsaid, the person is more likely to continue doing it."

It's also important for bystanders to step in because not everyone will feel comfortable speaking up for themselves.

"You have a lot of power if you stand up as a colleague, a friend and a supporter and say, 'This is not okay. I witnessed this as a third party, and it needs to stop," said Dr. Killeen.

Addressing academics

Academic appointments can be particularly challenging for women, who are almost six times more likely than their male colleagues to leave a position at the assistant professor level within two years due to the demands of balancing clinical practice, medical students, research and family responsibilities.

"There are a lot of responsibilities and expectations," said Dr. Damitz. "The goal is to try to balance all of those responsibilities – teaching, scholarship clinical care of patients and then, life in general. There are lots of moving parts."

Michele Manahan, MD, a professor of Plastic and Reconstructive Surgery at Johns Hopkins University School of Medicine in Baltimore, said it's important to know what to expect before pursuing an academic career.

"Maybe it's the institutional rules and regulations that drive some away from it," said Dr. Manahan. "It means a little less ability to make your own decisions, but I do think there is room to be able to shape an academic career to make it match your goals and desires and plans for outside of work as well."

Women plastic surgeons are also underrepresented as speakers at scientific conferences. A 2020 study in the Annals of Plastic Surgery found women comprise about 15 percent of speakers, instructors, moderators and panelists across all plastic surgery meetings. To solve this inequity, however, may simply be a matter of asking more women to participate.

"It's really about continually, persistently, consistently being supportive of those around us," said Sara Dickie, MD, a board-certified plastic surgeon in suburban Chicago. "If you're in a position of leadership, you're in a position to invite someone to a podium or put someone on a panel."

Dr. Hamilton said she had opportunities because a male mentor recommended her as a speaker.

"I know for a fact that he submitted my name to be considered for presentations," said Dr. Hamilton. "It's really about relationships. Since there are more men in leadership positions, it's important that our male mentors advocate for us, and so many of them do. Their support speaks volumes about our Society."

Solutions for success: The magic of mentors

Of course, having a woman as a mentor can be a powerful way to show other women what is possible, but it's not always easy to find one. Dr. Damitz suggested women actively reach out to other women beyond their local areas for support.

"Finding a mentor locally can be challenging for some," said Dr. Damitz. "But there are always people regionally or even across the nation who can help.

Michele Shermak, MD, a board-certified plastic surgeon in Timonium, Md., said most of her mentors were men, many of whom were supportive – but also recommends proactively seeking mentors.

"Mentors aren't looking for mentees," said Dr. Shermak. "Mentees need to find people that they want to connect to. My advice is if they find someone they admire, set up a time to meet – [mentors are] so thrilled and flattered that somebody is interested. There is no mandate that women have to have women as mentors. There are a lot of great male mentors of women."

Dr. Mahmood advocates also reaching out to mentors beyond medicine, especially since social media makes it easier for people to connect.

"I constantly look at women entrepreneurs, female leaders of any specialty, and I really am inspired," said Dr. Mahmood. "I think a mentor can be anyone you find relatable and inspiring."

A fantastic future

As more women enter the specialty, opportunities across all aspects of plastic surgery continue to grow. The ASPS Women Plastic Surgeons (WPS) Forum is a powerful voice for advocacy and education within the Society, while the annual LIMITLESS Leaders program (an initiative managed by ASPS and sponsored by Allergan Aesthetics, an AbbVie company) provides leadership training for women who are early in their plastic surgery careers. Concerted efforts by ASPS to engage women plastic surgeons as faculty in scientific meetings and committee leadership have also benefitted the Society and specialty as a whole.

"I'm extremely excited about the future of plastic surgery," said Dr. Gallus. "Millennial women residents speak up for what they want. They feel empowered. Their views on how the specialty should go are often inspiring and really moving things forward."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.