Bridging policy and practice: Recommendations for parental support in plastic surgery

Pregnancy, parental leave, and lactation remain challenging for surgical trainees, yet specialty-specific data in plastic and reconstructive surgery (PRS) are limited. This study evaluates resident and faculty experiences and perceptions to identify gaps between faculty beliefs and resident lived experiences surrounding parenthood and postpartum return to work.

Cross-sectional surveys were distributed to plastic surgery residents and faculty through the American Council of Educators in Plastic Surgery. Resident surveys assessed parental leave, lactation practices, and postpartum experiences. Faculty surveys examined attitudes toward resident pumping, perceived workflow impact, and institutional culture. Descriptive analyzes were performed.

34 residents and 54 faculty completed the survey, for response rates of 30.1 and 10.7%, respectively. Residents reported longer parental leave (mean 8.1 weeks) than faculty had during their own training (5.3 weeks), yet many still relied on vacation or elective time. Although 90.7% of faculty strongly supported resident lactation needs and 79.6% believed their institution fostered a supportive culture, 62.5% of lactating residents stopped breastfeeding earlier than intended, citing insufficient time, distant lactation spaces, and pressure to maintain workflow. One-quarter felt uncomfortable pumping around faculty, and over one-third experienced lactation-related medical complications. Postpartum mood symptoms (55.6%) and guilt (63.6%) were also prevalent among trainees.

Disparities persist between faculty and resident perceptions of parental leave and lactation support during residency training. Improving parenthood in plastic surgery requires coordinated infrastructure, support for flexible lactation practices, policy enforcement and promotion, and cultural change. Aligning policy, practice, and expectations is essential to support resident well-being, promote equity, and strengthen the plastic surgery workforce.