Do I have gynecomastia or pseudo gynecomastia? The skin under the nipple is a little hard. (Photos)

You probably have a component of gynecomastia, and surgery would improve this.  If it ever bothers you or you become self-conscious about it, consult with a board certified plastic surgeon who can use liposuction and excision of the glandular tissue to treat it.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

You have gynecomastia up front with puffy nipples. There is no such thing as pseudogynecomastia. It's an unhelpful term, wishful thinking and should be removed from the dictionary.Gynecomastia is the appearance of a female like breast in a man. If your chest looks more like a female chest then you have it. It's caused by the excess of tissue on the chest. The most common cause is leftover tissue from the changes that occur in all males at puberty. It's harmless but it gets into you head and ruins your life. That's why you seek help and why we treat it. 

Gynaecomastia is a condition that affects males when they get breast gland development under the nipple. It can be very small or minimal growth, called grade I or fairly large and ptotic called Grade IV.
You seem to have a very small gland under the nipple. It is causing the nipple to protrude. It is also called puffy nipple syndrome. It could be classed as Grade I. As you are lean, there is not a lot of fat in the gland. A minimal liposuction around the edges could be done to leave only fibrous gland before excising the gland. Or simply through a tiny access sub nipple incision, the gland can be excised. That should cure you permanently.

Thank you for the question and picture. Accurate diagnosis would necessitate physical examination. It IS important to differentiate  as uncomfortable as gynecomastia ( excess breast tissue) from lipomastia ( otherwise known as pseudo-gynecomastia or excess adipose tissue of chest wall). Treatment will differ depending on diagnosis. Having said that, your photographs and description are most consistent with the presence of gynecomastia.
Generally speaking, liposuction surgery alone is useful to treat lipomastia (an enlarged chest secondary to adipose tissue); rarely does it suffices as the only modality of treatment when it comes to treating true gynecomastia. Most patients with gynecomastia benefit from direct excision of glandular tissue plus/minus peripheral liposuction surgery.
My best suggestion: seek consultation with board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. You may find the attached link helpful to you as you learn more. Best wishes.

You have a clear case of typical gynecomastia. If it bothers you, obviously it does you can seek its surgical removal.

I agree with my colleague that your photographs likely show glandular breast tissue that sits behind and within the areola.  I would recommend that you see an experienced plastic surgeon to discuss the development of the condition and to have a thoughtful physical exam.  It is always important to determine if this is breast growth that has occurred as part of normal development, or if it is in response to a medication or medical condition.  Rest assured that a smooth, flat chest can be achieved by excising the tissue either directly or in conjunction with liposuction, and there are treatments for the "puffy nipple."  Many patients are able to have surgery under local anesthesia with oral sedation in an office setting, as well.  Consider a consultation with a Board Certified provider.  

Thank you for the photos and you appear to have gynecomastia which could be confirmed with an examination by an expert in the fieldDr Corbin

You have gynecomastia. In your case there is a glandular component and a fatty (adipose) component to your breast.

Hello, you have gynaecomastia -grade 1. Its gland under your nipples which makes nipple show through the clothes. This can be addressed by gland removal under local anaesthesia . Psudogynaecomastia is found in obese people only. 

Thank you for your question in photographs. In situations such as yours, in an overall thin chest wall, the cone-shaped nipple is due to true breast tissue sitting just behind the areola. In my experience, this will require both liposuction of the chest wall and excision of the breast tissue through the areolar margin. I recommend you find a plastic surgeon in your region with demonstrated expertise in cosmetic breast surgery. Best of luck.