Navigating family planning and career development in plastic surgery

Women in plastic surgery training face distinctive challenges in aligning reproductive health and family planning with the rigors of a demanding surgical career. With long training durations, competitive program cultures, and late entry into practice, childbearing during residency is often delayed or deprioritized. At the same time, plastic surgery has made measurable advances in gender representation, institutional policy, and cultural acceptance of pregnancy during training. No doubt, the progress that has already occurred over the must be explicitly recognized alongside ongoing gaps. To characterize these pressures, we conducted a narrative review of PubMed/MEDLINE and professional society resources (2000-2025) as well as a systematic PubMed search (2015-2025) that identified 11 quantitative studies specific to plastic surgery residents. Key domains included pregnancy timing, parental leave, fertility, disclosure, lactation, mentorship, and work-life balance. Across studies, many trainees reported postponing pregnancy and receiving minimal fertility counseling. Roughly 40% were dissatisfied with existing leave policies, and 20% delayed childbearing due to training demands. Small program sizes and intense competitiveness may heighten stigma around pregnancy, while insufficient institutional support, limited childcare, inadequate lactation facilities, and rigid scheduling amplify stress. Obstetric complications appear more common among surgical trainees compared to non-surgical peers. Although the American Board of Plastic Surgery allows up to 12 weeks of leave during residency, this is often insufficient to accommodate combined parental, medical, and family emergency needs. Importantly, recent literature also reflects increased program-level awareness and improving norms around parenthood, with growing attention to formal leave policies, lactation support, and trainee wellness. Addressing these systemic, cultural, and biological barriers requires multi-level action: reforming institutional policies, expanding support resources, fostering mentorship, and normalizing parenthood in training culture. This manuscript aims to support continued progress by pairing transparent discussion of persistent challenges with practical recommendations and examples of evolving best practices, with the goal of strengthening and not discouraging, future trainees' interest in plastic surgery.