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

## TL;DR

A new surgical technique for correcting advanced gynecomastia in post-bariatric patients preserves natural chest appearance and sensation with minimal scarring and high satisfaction.

## Contribution

Introduces a glandular transposition technique that avoids free grafting and preserves the nipple–areolar complex in post-bariatric gynecomastia correction.

## Key findings

- No major complications occurred, with preserved NAC viability and sensation in all patients.
- Patient satisfaction scores improved significantly from preoperative to postoperative assessments.
- Postoperative chest appearance scores increased substantially, with 90% of photo-pair comparisons favoring the results.

## Abstract

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.