I have puffy nipples but I don't know if it is fat or gynecomastia.

"Puffy Nipple Areola Complex" is among the most common forms of gynecomastia. This gland and/or adipose tissue accumulation can be located under the areola or can be slightly extended outside the areola, causing the areola to appear dome shaped.This form of #Gynecomastia can be found in all age groups but is more common in young adults.As each case is different, it is vital that you consult with a board certified plastic surgeon who is experienced in male breast surgery. The surgeon should determine if you are a suitable candidate for male breast reduction by liposuction or glandular excision. It is also crucial to have a plastic surgeon who is well-versed in the gynecomastia condition can determine if there is firm breast tissue beneath the areola that is causing the nipples to project (which is often the case), and if so, how much of this glandular tissue can be removed to create a flat appearance.#PuffyNipple surgery generally takes only an hour or two, and the recovery time is short; sometimes less than a week. There is minimal scarring and the success rate is excellent. Therefore, patients who suffer from "Puffy Nipples", and who view it as an unaesthetic and unpleasant condition, may desire surgical intervention to correct the "puffy nipple" condition. Men who suffer from large #areolas may notice that after breast surgery, the skin of the chest muscles will tighten, causing the areolas to tighten and diminish in size. This is a result of the removal of glandular and/or adipose tissue.

This could easily be gynecomastia but without photos and examination hard to tell for certain. You probably have grade I or Nummular gynecomastia.  This is something that can be improved with an office procedure in my hands.Good luckDr VasishtSouth Shore Plastic SurgeryVoorhees, NJ 

It is really impossible to say without an exam. In general, the nipple and areola tissue will contract when stimulated by either digital pressure or cold temperatures. Nipples that shrink when pressed are normal. Elongated nipples may just be elongated nipples. Many patients have nipples that are larger than average but do not have gynecomastia. Gynecomastia refers to overdevelopment of the tissue deep to the nipple and areaola that causes a feminization effect on the chest of a male.

Thank you for the question. Accurate diagnosis would necessitate physical examination. It IS important to differentiate gynecomastia ( excess breast tissue) from lipomastia ( otherwise known as pseudo-gynecomastia or excess adipose tissue of chest wall). Treatment will differ depending on diagnosis. 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.

Gynecomastia is not fat ,but gland,
How should I choose a surgeon?
Selecting a surgeon is as important a choice as the decision to undergo surgery. Choose carefully only a board certified PLASTIC SURGEON. The decision is yours. What follows is some advice to assist in making your selection.
1. Experience matters. Choosing a surgeon who has performed over one thousand gynecomastia cases increases the likelihood that they have seen a case similar to yours in the past. Selecting a surgeon whose practice is focused on gynecomastia exclusively is also an indicator of experience.
2. Results matter. The more before-and-after pictures a surgeon displays, the better. Pay attention not just to the number of pictures, but whether the surgeon is confident enough to show multiple angles of the same patient.
3. Gynecomastia surgery Reviews matter. Have patients reviewed your surgeon? Did those patients undergo the surgery you are considering?
4. Expertise matters. Is your surgeon recognized by the profession as an authority in the field? Are they certified by the American Board of Plastic Surgery? Have they authored books or medical journal articles regarding your surgery?

We hope these guidelines are of assistance when you are selecting your surgeon. When undergoing surgery, it is very important to be realistic about your expectations. Past results are not a guarantee of future results. Also, revision surgery tends to be significantly more difficult than initial surgery.