March 2026 Edition

thestitchprs
Mar 2
5 min read

15 min read

Welcome to the March edition of The Stitch. This month, we’re diving into the often-unspoken emotional impact of adverse outcomes in surgery and exploring the reality of second victim syndrome. In honor of Women’s History Month, we’re also celebrating the women who helped shape plastic surgery — from the pioneers who pushed open doors to the growing number of women redefining the field today. And because even meaningful conversations deserve a little levity, we’ve included a fun crossword puzzle to keep things light!

As you continue your journey in plastic surgery, we hope this issue offers something meaningful to carry with you!

The Stitch Editorial Board

Invisible Wounds in the Operating Room: Second Victim Syndrome in Surgery

Article by Fatima Khan, University of Toledo College of Medicine & Life Sciences Class of 2027

Adverse outcomes are an inevitable part of surgery. Even in the most meticulous hands, complications happen: tissue bleeds, anastomoses leak, wounds don’t heal. The practice of surgery is grounded in precision, but it is not immune to uncertainty.

The term “second victim” was introduced by Albert Wu to describe the emotional trauma experienced by a clinician who feels responsibility for an adverse clinical outcome. While the patient is the first and most important victim, the surgeon may become the “second” -- internalizing guilt, shame, self-doubt, and a profound sense of personal failure.

Second victims may experience

Rumination about intraoperative decisions
Fear of litigation or professional repercussions
Loss of confidence in technical ability
Sleep disturbances
Emotional withdrawal
Reluctance to take on similar cases

In surgery, where identity is often intertwined with technical mastery and decisiveness, an adverse outcome can feel deeply personal. The culture of surgery -- historically stoic, performance-driven, and hierarchical -- may unintentionally discourage vulnerability. Surgeons are trained to project calm in crisis. Yet the same composure can make it difficult to acknowledge emotional distress afterward.

Surgeons rarely seek formal support after adverse events. Most confide quietly in trusted colleagues, without a formal structure, making peer support their main coping mechanism. However, the consequences of leaving the second victim's distress unaddressed are significant. Persistent emotional strain may contribute to:

Burnout
Defensive medicine
Reduced career satisfaction
Early departure from surgical practice

Ironically, a profession devoted to healing can struggle to create space for its own recovery. To move toward healing, addressing second victim syndrome requires more than individual resilience. It requires cultural change. Institutional approaches may include:

Structured peer-support programs
Morbidity & Mortality conferences that focus on learning rather than blame
Protected spaces for confidential debriefing
Normalizing emotional processing as part of professional development

For trainees, this conversation is especially important. Medical students and residents observe how attendings respond to complications. Silence or self-criticism sets one example. Transparency, accountability, and compassion establish another. Surgery demands technical excellence, but lasting excellence needs psychological safety.

Threads of Change: Women in Plastic Surgery

Article by Jenna Billingsley , University of South Florida Morsani College of Medicine Class of 2027

March is Women's History month! The history of plastic surgery is often told through its techniques and breakthroughs, but just as important are the women who carved out space in a field that did not initially welcome them.

For much of the twentieth century, surgery – and particularly plastic surgery – was overwhelmingly male. Women who pursued the specialty entered environments where mentorship, leadership roles, and professional societies were not built with them in mind. Despite these barriers, several pioneers established careers that have shifted the trajectory of the field.

One of the earliest and most notable was Alma Dea Morani. In 1941, she became the first woman admitted to the American Society of Plastic and Reconstructive Surgeons. Over a career spanning more than five decades, she practiced, taught, and mentored at Yale – helping train generations of plastic surgeons. At a time when women in surgery were rare, her presence was itself transformative.

Progress since then has been steady, though gradual. According to the American Society of Plastic Surgeons (ASPS), women now represent approximately only one-quarter of board-certified plastic surgeons in the United States. A recent ASPS article examining gender parity in plastic surgery notes that while medical school classes are nearing equal gender distribution, the proportion of women narrows within surgical subspecialties and decreases further at senior academic and leadership levels. The article emphasizes that achieving parity involves not only recruitment, but sustained mentorship, sponsorship, and structural support throughout a female surgeon’s career.

Plastic surgery occupies a unique intersection in medicine. It encompasses breast reconstruction after cancer, trauma and burn reconstruction, congenital differences, aesthetic procedures, and gender-affirming care. As the specialty has diversified, so too have the perspectives shaping how these procedures are discussed – with increasing emphasis on restoration, autonomy, and patient-centered outcomes.

The earliest women in plastic surgery entered a field where representation was rare. Fortunately, that landscape is gradually changing. Recent data from the American Society of Plastic Surgeons show an increasing number of women in plastic surgery training programs, reflecting a pipeline that looks markedly different than it once did. The contributions of those early surgeons extended beyond operative skill and their persistence helped lay the groundwork for a more inclusive future.

Women’s History Month serves as a reminder that many of these shifts are recent. Plastic surgery continues to evolve – not only through innovation, but through the growing diversity of those who practice it.

As more women enter and lead within the specialty, the field becomes stronger, more representative, and better equipped to serve its patients. The trajectory is clear: a future shaped by skill, collaboration, and a broader range of voices than ever before.

References

Bucknor, A., Kamali, P., Phillips, N., Mathijssen, I., Rakhorst, H., Lin, S. J., & Furnas, H. (2018). Gender inequality for women in plastic surgery: a systematic scoping review. Plastic and reconstructive surgery, 141(6), 1561-1577.
Goodman, M. P. (2011). Female genital cosmetic and plastic surgery: a review. The journal of sexual medicine, 8(6), 1813-1825.

March 2026 Crossword

Piece by Makenna Ley, University of Arizona Class of 2028

This month’s crossword dives into core plastic and reconstructive surgery concepts straight from the clinic and the OR. See if you can connect the nerves, name the deformities, and stitch

the grid together!