Is fat removed during gynecomastia surgery?

Thank you for your question. In gynecomastia surgery, fat removal depends on the method used. If liposuction is performed, fat will indeed be aspirated and removed. If surgery involves direct tissue resection around the areola, very few fat cells will be removed.
Asymmetries, such as uneven fat distribution, are typically corrected during surgery. In cases with significant excess skin, an additional incision might be made across the chest or under the breast to remove it.
I hope this concise answer clarifies your question.

Depending on your anatomy and how much fat is surrounding the gland, most surgeons will do gland excision with some liposuction to contour the chest and avoid the uneven contour you're describing. Most surgeons hide the incisions at the border of the areola. A scar underneath the areola is only necessary when there's a lot of extra skin, namely in massive weight loss patients.