The narrow space of legitimacy: A personal perspective on positioning, perception and gender in surgical careers.

Despite decades of progress in formal equality, women in surgery continue to experience differential perceptions in terms of authority, leadership and legitimacy that are not captured by structural indicators alone. Drawing on the first-hand experience of a female plastic and reconstructive surgeon practicing as the only woman among senior surgeons in her department, this personal perspective examined how internalized norms, self-positioning and social expectations shape the lived experience of professional legitimacy in surgery. It explored how gender can function simultaneously as a clinical asset, fostering patient trust and as a source of additional scrutiny in academic and leadership contexts and discussed the psychological burden associated with equity policies such as gender quotas. This personal perspective argues that gender disparities in surgical careers cannot be attributed solely to structural inequalities and proposes broadening the definition of legitimacy to accommodate diverse models of authority. It concludes with practical recommendations, including structured mentorship, transparent authorship practices and sponsorship initiatives, to support a more equitable surgical culture.