Why won't puffy nipples go away after 2 surgeries and one liposuction? (Photos)

I don't think the technology is there to resolve all fullness behind the nipple/areola.  Ideally shrinking the skin while removing the gynecomastia would be ideal however the skin envelope contracts to a variable degree.  Additionally there may be some residual actually breast tissue present or some swelling that needs to resolve.  Best Wishes!!

An exam would be necessary to make a determination if additional surgery would be advised. If you have tried diet modifications (low cholesterol, testosterone enriched) and upper body strength exercise to no avail, you might apply Biofreeze occasionally during the hot summer days to reduce the puffy nipples.

Thank you for sharing your question and photographs.  Unfortunately without an in-person examination of your tissues it is impossible to offer the best advice.  If all of the glandular tissue has been removed, then the temperature fluctuations in your nipple and areola would be a normal tissue response.  If any gynecomastia remains then it would need to be removed.  Hope this helps.