Balancing act: Parenthood and professionalism for women in plastic surgery

Managing careers and families has always been a delicate balancing act for women. They are often told they can have it all, but the reality of working in a demanding specialty and the demands of being a working parent is challenging. Women plastic surgeons, however, agree that while it can certainly be difficult – it's not impossible.

"Women from the beginning – from when they start high school, medical school and certainly residency – are often given the signal that surgery is not a great option for them if they plan to have children or a family," said Katerina Gallus, MD, FACS, a board-certified plastic surgeon in San Diego. "They're basically being told 'no' from the get-go."

Women plastic surgeons face daunting odds when considering a family. They are at high risk for infertility, miscarriage and other pregnancy complications. A 2023 study in Plastic and Reconstructive Surgery found women plastic surgeons were less likely to have children and more likely to give birth to their first child at an older age in comparison to the United States population in general. Plastic surgeons face seven times higher odds of having difficulty conceiving or carrying a pregnancy to term than other American women. Also, their rate of miscarriage is twice the rate of the U.S. population.

"The reality is that there are too many barriers for women in this specialty," said Ashley Amalfi, MD, a board-certified plastic surgeon in Rochester, N.Y., who faced pregnancy complications during her residency. "We need to expand upon the old way of doing things and accommodate the needs of women, which differ from men. Maternal and fetal health is a startling concern and creates an unsafe environment for plastic surgery trainees and needs to be addressed urgently to pave the way for better diversity in our specialty."

Many women entering the specialty will postpone starting a family while they juggle intense studies, training and board examinations, which all often occur during their prime years of fertility. Karen Horton, MD, MSc, FACS, FRCSC, a board-certified plastic surgeon in San Francisco, said women in the specialty may need to consider a different path from their peers outside of medicine to start a family.

"Personally, I put off children until I was older, and I needed a little bit of help," said Dr. Horton. "I did IVF, and, thankfully, that worked well for me."

Working moms are models for the next generation

The work-life balance of a plastic surgeon and mom can be tricky, but, ultimately, Michele Shermak, MD, a board-certified plastic surgeon in Timonium, Md., said it can help children find their own path.

"There are benefits to having a working mom who has a career and who's doing such intensive work like we're doing," said Dr. Shermak. "There's an appreciation of respect and independence that develops from that."

"Your kids know you're their mother," said Sara Dickie, MD, a board-certified plastic surgeon in Morton Grove, Ill. "You don't have to be there every second. They are watching you, and they're actually learning from you. If they're females, they're learning to be strong and independent."

Two ways women in the specialty say they can set themselves up for success, whether they have children or not, is to establish boundaries and support. It begins by identifying priorities.

"My happiness is the most important thing," said Dr. Dickie. "It sounds so selfish, but I come first, and it's really made me able to balance a challenging specialty. I insist that myself and my family come first."

It's also important to understand that certain trade-offs may be necessary.

"If you choose to exercise for one hour, then you sleep one hour less," said Dr. Horton. "I'm taking more days off because of my children. I'm not seeing patients those days or doing surgery, so my income might be a bit less, but these are years you can't have back."

Then, set boundaries around your priorities.

"I tell people, 'This is what I expect. Period,'" said Kelly Killeen, MD, a board-certified plastic surgeon in Beverly Hills, Calif. "There is no discussion. If you want me here, this is what you need to provide me. I never had any pushback. It was told to me early on when I was a resident that you need to treat every aspect of your life with the same respect, and you need to put as much work into forming friendships and relationships as you do into forming the skillset to become a wonderful plastic surgeon."

"Make sure you're carving out time equally for your personal and professional life," said Dr. Gallus. "Generally, younger physicians are more firm about creating those boundaries. That has helped everyone set aside time to really deal with their personal lives."

Support is also crucial so surgeon-moms don't feel they need to do it all by themselves.

"The moment I found out I was pregnant, I tried to line up the night nannies so they would buy me time to find a daytime nanny," said Kristy Hamilton, MD, a board-certified plastic surgeon in Houston. "I'm thankful my parents live in the same city as me, so I know they can be available."

"I don't think you need to choose either career or family," said Dr. Horton. "You can do both, but you really have to surround yourself with people that are very supportive of you, whether that's family, a spouse, a good group of girlfriends or other cheerleaders to help you navigate that situation."

Leading the charge for change

As more women have taken on leadership roles in ASPS and across the specialty, recognizing and accommodating the unique needs of many female surgeons has become a priority.

"It has really created some opportunities for women to change and shift how the practice of plastic surgery is occurring and how our organization deals with issues like childbearing and maternity leave, having childcare at the meetings and offering lactation rooms at our meetings," said Dr. Gallus. "Those changes are not going to come around if we're not asking for them. Everyone benefits from that, both men and women."

Encouraging women to commit to a challenging career is essential to creating more diversity in plastic surgery.

"Don't give up on what you love," said Michele Manahan, MD, a board-certified plastic surgeon in Baltimore. "Make sure you find time for that. Make sure you fight for it, either in your professional or personal life. Do not let it slide."

"You don't want regrets," said Dr. Shermak. "There are tons of women who have really broken paths for us. We're smart. We're capable. We can do these things. We just need to pursue our passions. I truly think everything just falls into place with that, all the other things. You'll make it work. You just have to be passionate about what you're doing."

Many women in plastic surgery said they make a point to be advocates for other women so they can see balance in a career and family exists in the specialty.

"As women plastic surgeons, we are all part of a very elite group because there's not that many of us," said Dr. Horton. "It's a sisterhood. We really have to support and promote each other. The more, the merrier."

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.