On March 8, 2019, we celebrated International Women’s Day, a global day, which honors social, economic, cultural, and political achievements of women while simultaneously turning our attention toward the continued lack of gender balance present in today’s world. The Balance for Better campaign theme prompted a closer look at diversity within our plastic surgery specialty. Gender balance has improved with many organizational efforts and laws enacted in the United States. Unfortunately, despite these institutions, statistics show the trend toward financial and career success still favors men. Within the field of medicine, a similar trend has been observed. Though women constitute 50% of medical school graduates, the majority still enter fields outside of surgical subspecialties. In comparison to other surgical subspecialties, women are most represented in plastic surgery. Unfortunately, significant gender discrepancies remain in post-graduate practice including academic practice rank, societal board membership, invited speaker opportunities, and compensation, to name a few. The “leaky pipeline” of women describes a precipitous decline in women at each progressive step of the professional ladder. We explore the multi-faceted nature of this phenomenon and highlight contributing factors limiting female growth within the plastic surgery profession. We also emphasize the continued growth of female plastic surgeon presence in all sectors despite these existing obstacles. We submit that continued leadership, mentorship, and sponsorship provided by both male and female physicians in the field will facilitate future leadership, advance gender parity, and cultivate a sense of belonging within the plastic surgery community, allowing brilliant minds to flourish and the profession to thrive.

Breast hypertrophy creates a functional disability, adversely affecting quality of life because of disproportionate upper body weight. No study to date has prospectively shown or statistically proved (using validated questionnaires) the functional benefits of breast reduction surgery. Moreover, no study has quantified the physical findings seen in these patients. A prospective trial was designed to illustrate objectively the functional benefits of breast reduction surgery and answer the question, Does surgically removing breast tissue in symptomatic patients (regardless of amount of tissue removed) improve their physical disabilities related to breast hypertrophy, and in turn, improve their quality of life? Fifty-five consecutive patients with an average age of 38 years (range, 18 to 73 years) undergoing breast reduction surgery by the senior surgeon (L.A.C.) were recruited for this study. The North American Spine Society (NASS) Lumbar Spine Outcome Assessment Instrument was used to assess patients' disability, expectations for treatment, and satisfaction with treatment. The visual analogue scale was used to quantify pain intensity. Muscle strengths of the pectoralis major, pectoralis minor, rhomboid, middle trapezius, and lower trapezius muscles and postural measures were obtained. Information was collected preoperatively and 6 months postoperatively for comparison. The mean cumulative preoperative NASS Lumbar Spine Outcome Assessment Instrument disability score was 1.94 +/- 0.68, and the mean cumulative postoperative disability score was 1.16 +/- 0.35 (p = 0.0001); 96.1 percent of patients met expectations to a certain degree and, of these patients, 96 percent were very satisfied with their surgery. The mean cumulative baseline preoperative visual analogue score for all participants was 6.2 +/- 2.06, and their mean cumulative postoperative score was 0.53 +/- 0.88 (p = 0.0001). There was statistically significant improvement of muscle strength in the rhomboids, middle trapezius, and lower trapezius muscles (p < 0.001). All postural measures showed improvement postoperatively, with head translation and cranial rotation showing statistical improvement (p < 0.05). This single-center, single-surgeon breast reduction outcome study showed that the signs and symptoms of breast hypertrophy are definable in a consistent manner. By standardizing and quantifying preoperative and postoperative evaluations with validated questionnaires, validated pain scoring, and standardized muscle and posture testing, it was shown that breast reduction for symptomatic breast hypertrophy can effect a statistically significant improvement in these objective measures of pain, disability, muscle weakness, and poor posture.