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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. Editorial Decision date: October 22, 2019; online publish-ahead-of-print October 30, 2019. © 2019 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com The story of women’s struggle for equality belongs to no single feminist nor to any one organization but to the collective efforts of all who care about human rights—Gloria Steinem On March 8, 2019, we celebrated International Women’s Day, a global event that both honors the social, economic, cultural, and political achievements of women and focusses attention on the continued lack of gender balance in today’s world. This movement asks that we notice the gender discrepancies present in our own spheres of influence and calls on each of us to take action to achieve a better gender balance across all facets of life.1 Downloaded from https://academic.oup.com/asj/advance-article-abstract/doi/10.1093/asj/sjz299/5609346 by guest on 14 February 2020 2 Aesthetic Surgery Journal Gender balance in the United States has improved through organizational efforts and the enactment of laws. The Fair Labor Standards Act of 1938, the Equal Pay Act of 1963, Title VII of the Civil Rights Act of 1964, and the Pregnancy Discrimination Act of 1973 in conjunction with unified efforts of Affirmative Action and other movements aimed at diversity and gender assimilation are a few examples that have provided substantial opportunity to minorities (by gender, race, creed, religion, and handicap) for education and employment opportunities in addition to protecting these individuals throughout the duration of their careers.2 Unfortunately, despite these endeavors, statistics show that men still enjoy greater financial success and career growth.3 It has been postulated that choices made by women are responsible for these disparities. For example, Bolotnyy and Emanuel4 suggest that women value time away from work more than men and subsequently choose to work less overtime, take more unpaid time off, and avoid weekend/holiday shifts, which often pay more than regular work hours, all of which lead to lower pay for women. Similar claims have been made by Hutchinson et al5 linking decreased female earnings to socially mandated family work. However, a recent study by the International Labour Organization found that, when asked whether they preferred to work in paid jobs, care for their families, or do both, a staggering 70% of women worldwide reported a preference for working in paid jobs, indicating that the male-favoring trends currently observed are unlikely to be due to any lack of desire on the part of women to succeed professionally.6 Within the field of medicine, a similar trend has been observed. Although women constitute 50% of medical school matriculants, they represent only 39% of full-time faculty in academic medicine with an even weaker presence seen in leadership roles.7 Female physicians are more likely to be undercompensated, are less likely to progress in academic rank, and have higher attrition rates than their male counterparts.8-10 The Balance for Better campaign theme (#BalanceforBetter) of the 2019 International Women’s Day prompted a closer look at diversity within our plastic surgery specialty.1 A Closer Look at the History and Presence of Women in Plastic Surgery The first known surgical practices in the world date back to 5000 BCE France when trepanation was used to treat a myriad of intracranial issues.11 The first evidence of plastic surgery arrived centuries later with writings by the Indian surgeon Sushrata in 600 BCE.12 Surgical texts from this era offer evidence of women playing active roles in surgery throughout Egypt, Italy, and Greece.13 However, female presence in surgery shifted drastically in the Middle Ages with the implementation of various regulations and laws across the world, banning women from surgical and medical practices alike.13 The return of women to medicine was an arduous journey where secrecy and disguise were required for entry into practice. Dr Miranda Stewart, the first female surgeon in Britain and Canada, concealed her true identity, dressing and practicing as a man to gain entry into medical and surgical training programs. She and Drs Elizabeth Blackwell, Emily Jennings Stowe, and Harriet Jones, to name a few, are significant historical figures, who, through their sacrifices and persistence, paved the way for the re-entry of women into medicine in North America.13,14 It was not until 1913 that the American College of Surgeons first recognized women surgeons, and another 30 years would pass before the welcome of the first female plastic surgeon, Dr Alma Dea Morani, in 1948.14,15 Even during her training, Dr Morani was accepted initially with observationonly privileges and was eventually afforded operating privileges only during off-hours when her male colleagues were not using the operating rooms.14 The collective efforts of past women are now evidenced by nearly a decade of females comprising 50% of medical school
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