Glandular Transposition Technique for the Correction of Advanced Gynecomastia in Post-Bariatric Patients: A Case Series on a Conservative Strategy for Natural Aesthetic Outcomes.

Background and

Objectives

Advanced gynecomastia/pseudogynecomastia (Simon grades IIb-III) in post-bariatric patients presents both esthetic and technical challenges. Conventional excisional methods often result in flattened chest contours, extensive scarring, and loss of nipple-areolar complex (NAC) sensation. There is a growing need for conservative, tissue-preserving strategies that respect the unique morphology of massive weight-loss patients. Materials and

Methods

This consecutive case series included 15 male patients (median age: 38 years, IQR 36.5-39.5) with advanced gynecomastia/pseudogynecomastia and stable weight loss following bariatric surgery. All underwent a glandular transposition technique, preserving the NAC on a pedicle based on thoracic perforators and avoiding free grafting. Redundant lower-pole skin was excised, a new NAC site was created cranially, and the gland was repositioned beneath a dermo-adipose flap. Outcomes included complication rates, patient satisfaction, and changes in BODY-Q chest appearance scores.

Results

No major complications occurred. NAC viability and sensation were preserved in all patients. One patient required secondary revision for residual contour bulging, while three developed minor hematomas that resolved spontaneously. At 3 months, the median Likert satisfaction score improved from 2 (IQR 2-3) preoperatively to 5 (IQR 4-5) postoperatively (p < 0.001, Wilcoxon signed-rank test). BODY-Q chest appearance scores improved significantly from 31 (IQR 28-35) to 78 (IQR 74-82) (p < 0.001). External observers preferred postoperative results in 90% of randomized photo-pair comparisons.

Conclusions

Glandular transposition is a safe, reproducible, and esthetically effective technique for advanced gynecomastia/pseudogynecomastia in post-bariatric men. By preserving glandular continuity and avoiding free NAC grafting, this method achieves natural chest projection, maintains nipple sensitivity, and provides high patient satisfaction with minimal complications. It represents a compelling alternative to conventional radical excision strategies.