Thank you for your question and photos. Based on this, you do have breast gland excess (puffy nipples) and also excess fat. For patients presenting with these concerns, I would do VASER liposuction of the gynecomastia and lateral chest wall to define the pectoral muscles and remove the gland via small intra-areolar (within the dark skin under the nipple) incisions. This will result in scars that are highly camouflaged and minimal on the chest. The stage does not matter; the treatment is the same. The only difference is that in larger gynecomastia, patients with loose skin and in older patients, a skin tightening procedure like Renuvion is done at the same time. While this information can give you an idea of your options, it is impossible to formulate a surgical plan from photos alone. I highly recommend scheduling a consultation with a board-certified plastic surgeon experienced in male aesthetic surgery. Several examples can be seen on my website.