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

<i>Background and Objectives</i>: 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. <i>Materials and Methods:</i> 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. <i>Results</i>: 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 (<i>p</i> < 0.001, Wilcoxon signed-rank test). BODY-Q chest appearance scores improved significantly from 31 (IQR 28-35) to 78 (IQR 74-82) (<i>p</i> < 0.001). External observers preferred postoperative results in 90% of randomized photo-pair comparisons. <i>Conclusions</i>: 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.