Hi Serge,Thank you for your questions and your pictures regarding male breast tissue or gynecomastia. I commend you on your working out and losing another 25 to 35 pounds. Further weight loss may burn off some of your breast fat. However, unfortunately, I do not think that you will lose a significant amount of your male breast fat. This male breast fat is notoriously stubborn and resistant to weight loss.From your pictures and history you do have gynecomastia. As you know, gynecomastia is excess male breast tissue. In your particular case, you have excess male breast tissue, excess male breast skin, and Grade 3 ptosis of the nipple. Grade 3 ptosis means that the nipple is at the inferior most portion of the breast. If your breast do not significantly change after your 25 to 35 pound weight loss, you will probably require surgery. During your male breast surgery, excess male breast tissue, male breast fat, and male breast skin need to be removed. In addition, during your male breast surgery, your nipple needs to be raised and centered.In your particular case, an incision needs to be made underneath your breast. This is in the inframammary fold; the inframammary fold is where the breast meets the chest wall. Through this inframammary fold incision excess male breast tissue and excess male breast skin can be directly removed. In addition, in order to reposition the nipple, an incision needs to be made around the areola. A vertical incision does not need to be made.Male breast reduction surgery for gynecomastia takes about three to four hours. Gynecomastia reduction surgery is done under general anesthesia. Typically, gynecomastia surgery is performed as an outpatient, meaning that you go home the same day you came in for surgery. Recovery takes approximately 7 to 10 days.It is very important that you were your compression garment for at least 6 to 8 weeks after your gynecomastia surgery. To optimize your gynecomastia reductionresults and flatten your scars as much as possible, I strongly encourage silicone cream and silicone tape. These should be applied for at least six months.Good luck! Thanks again very much for your question regarding male breast reduction and gynecomastia. If you have any questions regarding gynecomastia or male breast reduction surgery, please do not hesitate to contact my office. Sincerely, Dr. Katzen