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At age 19 if you're gynecomastia has been established with little chance of regression, removal by excision or liposuction is fairly easy to do. The choice depends upon the relative amount of glandular tissue versus fatty tissue.
If you have tissue under the areola that is causing the puffiness then it may be able to be excised using a small incision around the areola.
you have gynaecomastia with asymmetry. this can be corrected through liposuction with or without disc excision depending on the nature of the breast disc. Nilesh Sojitra
Undoubtably you have some form of gynecomastia which often may only be isolated underneath the nipples. In most cases this can be removed by an open excision through a lower areolar incision. This may or may not need to be supplemented with liposuction to feather the excision into the surrounding chest tissues for a smooth chest contour. The amount of breast tissue that needs to be removed is often much bigger than one would think.