Hello, Thank you for your question regarding puffy nipples and the plastic surgery treatment of puffy nipples. It appears from your pictures that you have glandular tissue underneath your nipple areolar complex. For definitive treatment and correction of puffy nipples, I would suggest VASER assisted liposuction to remove this sub-areolar glandular tissue. VASER liposuction to remove male breast gland tissue forgynecomastia is usually very successful. Please seek an experienced, board-certified plastic surgeon for the treatment of your puffy nipple and gynecomastia. Again, thank you for your questions regarding puffy nipples and the treatment for gynecomastia. Before you make any decisions regarding surgical treatment of puffy nipples, I wouldsuggest you seek consultation with an expert. Please seek an experienced, boardcertified, plastic surgeon. Travel out of state if you must to find such gynecomastia correction expert. If you have any more questions regarding gynecomastia surgery or plastic surgery in general, please contact my office.Sincerely, Dr. Katzen. (Certified by the American Board of Plastic Surgery and member of the American Society Plastic Surgeons, International Society of Aesthetic Plastic Surgery, American Academy of Cosmetic Surgery, and Fellow of American College of Surgeons and American Board for Metabolic and Bariatric Surgery)