Upcoming follow up, what is the best way to address these concerns? (Photos)

Just based off your photos (and not a physical exam) - perhaps behind the nipple areola - the surgeon removed a little more than anticipated which allows for the dent look. Open the conversation with them and state that is there any revision or future procedures that can be done to improve this outcome. (Usually want my patients to wait 8-12 months to really see what the full outcome is) - possible need a little more lipo done medially and maybe able to use that fat to place back under the nipple to help with the deformity. But definitely keep the weight done and keep to high protein and weight lifting to decrease your body's fat percentage to see this defect less.

Thank you for your question regarding the upcoming follow-up meeting with your plastic surgeon and how to address your concerns after the gynecomastia surgery performed four months ago. Thank you for your history and your pictures, regarding what to do. First, it is important to have a clear idea of your expectations. What don’t you like? If your plastic surgery had a magic wand, what would you look for? Gynecomastia surgery is a reducing surgery. That means tissue is taken away. Specifically, gynecomastia is a surgical procedure where male breast tissue and fat are removed. This is what leads to your postoperative appearance. Fortunately, you’re still healing, and it will take several more months before the scar settles down. The “weird cord“ that you feel running down your chest is probably scar tissue. This should resolve on its own. Conservative movements like deep tissue massage and vibration therapy can diminish the weird cord.
Regarding options, there are conservative options and interventional options. Conservative options include losing more weight and exercising. Your muscle-building exercises should concentrate on the pectoralis region. This would include pectoralis major work, including push-ups and lifting weights. Interventional procedures can be done to improve the contour of the chest. Specifically, you may consider pectoralis major implants. Pectoralis major implants offer a fantastic result with long-lasting results. Pectoralis major implant insertion is a relatively straightforward surgery in experienced hands. Thank you for your interesting question regarding what to do with your follow-up after gynecomastia surgery done four months ago.
It will be very important to discuss your specific concerns with your plastic surgery. If you feel a revision is necessary, you should mention this directly to your plastic surgeon.
Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Four months after surgery is considered early to evaluate result. It will take at least one year for wound to mature and scars to soften and settle. The entire area where your surgeon did liposuction and removed the gland is a scar and what you see now is a scar retraction causing deformity. As scar matures this is going to look softer. Worst case scenario, down the road (not sooner than 1 year after surgery) injection of fat grafts may correct mild deformity if present. Hope this helps.

Thank you for posting your question here!My answer will be limited by the data and pictures provided for a detailed and personalized plan I would recommend consulting with your surgeon in person.I am sorry that you are disappointed with your results so far , you seem to have put in the work as you look leaner in the after pictures. I would recommend honesty when talking to your surgeon , as a plastic surgeon our ultimate goal is patient satisfaction and if you relay your concerns to your surgeon I am sure they will strive to improve the outcome if they believe they can do so.it is hard to tell for sure from the pictures but there might have been some over resection done which can result in the crater effect that you see, gynecomastia surgery is a delicate balance and it is easy to over resect , this can be improved with a revision surgery , I would wait though before venturing into a revision surgery until you are at least 6 months out and things have settled down. Again I would encourage you to relay your concerns to your surgeon so they can come up with a plan that works for you.I hope this helps, best of luck!