Diversity, Equity, and Inclusion in Plastic Surgery in 2026: An Updated Review and New Recommendations.

BACKGROUND: The June 2023 Supreme Court decision against affirmative action and the November 2024 US election impacted American universities and companies nationwide, many of which have ended their diversity, equity, inclusion (DEI) programs. This review was undertaken to assess the impact of these events, if any, on DEI publications in plastic surgery. It also examines the core issues-barriers to minorities, equity, a leaky pipeline, and racial concordance. METHOD: Six plastic surgery journals were queried from January 2024 to December 2025 using the search term "diversity." The recommendations and keywords were evaluated. RESULTS: Sixty articles were identified. Publications commonly evaluated racial and gender compositions of plastic surgery trainees, academic surgeons, websites, presentations, and publications. Frequent keywords included: diversity, inclusion, mentorship, equity, underrepresented, disparity, barriers, and a leaky pipeline. The publications uniformly made recommendations in favor of DEI initiatives. The recruitment and sponsorship of underrepresented applicants was a common theme. DISCUSSION: The plastic surgery literature almost exclusively supports DEI initiatives. However, recent federal lawsuits underscore the risk of continuing racial preferences, which have been ruled unconstitutional by the US Supreme Court. Many keywords and recommendations contrast sharply with the US Supreme Court decision. Moreover, an unrecognized shift in demographics has taken place over the last 4 decades. Whites are now underrepresented in medical schools compared with the US population. CONCLUSIONS: It has not been demonstrated that Blacks or Hispanics are underrepresented because of barriers. The evidence shows that there are simply fewer Black and Hispanic applicants entering the pipeline, as opposed to a "leaky pipeline." Racial concordance - aligning providers and patients by race - cannot be condoned. The need for continued pro-DEI publications that overlook the constitutionality and legality of their recommendations warrants reconsideration.