BACKGROUND Resident attrition is defined as the termination of a resident from his or her designated training program before completion, whether voluntarily or involuntarily. There are 2 types of plastic surgery programs: the 6-year integrated pathway and the 3-year fellowship or independent pathway. This diversity in resident backgrounds creates a complex setting for evaluation of resident attrition. Attrition in plastic surgery is poorly characterized in the literature, with previous studies estimating a 3.1% attrition rate in independent programs and indicating that independent residents may have a higher rate of voluntary attrition with integrated residents having higher rates of involuntary attrition.1,2 There has been no mention of risk factors for attrition. The aim of this study is to identify risk factors, note differences between pathways, and ultimately provide insight into resident attrition from plastic surgery residencies. METHODS An anonymous, multiple-choice and short answer, online survey was designed with Institutional Review Board approval. Surveys were sent to all plastic surgery program directors (PDs) in the United States. PDs were instructed to focus on the previous 10-year span from 2003 to 2013 and answered questions about resident attrition from their program. PDs were asked to surmise attrition rates and pathways most at risk. Outcomes measured included demographics of the program and attritional resident, timing and reasons for attrition, and possibility of preventing attrition. RESULTS Thirty-three of 95 PDs (35%) responded. PDs estimated attrition rates for plastic surgery at 6% (range 0%–17%). A majority of PDs (82%) assumed that integrated residents would be higher risk for attrition, attributing immaturity, and lack of exposure. Average attrition rates were calculated at 2.14% for independent and 0.85% for integrated programs, or 3.0% overall. Risk factors for attrition for both pathways included being single (P < 0.0001), divorced (P < 0.01), male (P < 0.05), and having no dependents (P < 0.001). One hundred percent of independent residents left by year 2 and 86% of integrated residents left by year 4. Lifestyle and loss of interest were most sited reasons for attrition. Three total residents underwent involuntary attrition (2 integrated, 1 independent). The majority of independent residents returned to their original field of training, whereas the integrated residents were more likely to transfer to another plastic surgery program. Of PDs responding, only 17% believed attrition could have been prevented. CONCLUSIONS Approximately 3.0% of plastic surgery residents underwent attrition during our study with independent residents at more risk for voluntary attrition and integrated residents for involuntary attrition. Being single, male, divorced, or having no dependents increases the risk of attrition in plastic surgery residencies. This is the first study to focus solely on plastic surgery attrition rates and demonstrate potential risk factors for plastic surgery residents undergoing attrition. Further research is warranted to help identify at-risk residents and prevent unnecessary attrition.