Confused about gynecomastia. Can puffy nipples just be fat? There was no gland after doing lipo and periareolar incision (Photo)

Gynecomastia is, literally, "breast GLAND presence in a male"! there is nothing to think, detect/miss, it is always a glandular problem with a larger or smaller fatty component, liposuction is NOT the treatment of gynecomastia vera.

Thank you for the question.
Gynecomastia comes from the Greek meaning "gyne" meaning woman and  "mastos"  meaning breasts.  It refers to abnormal development of large mammary glands in males.  The diagnosis can be made by physical examination where relatively firm tissue  (breast gland tissue) can be differentiated from relatively soft tissue (adipose tissue).
Breast prominence due to excessive adipose tissue is called pseudo-gynecomastia or lipomastia.  The differentiation of true  gynecomastia  from adipose tissue is important because the surgical treatment may differ. I hope this helps.