18 year old male. Puffy nipples since middle school. Is this gynecomastia that won't fix with time? (Photo)

Yes, you have small gynecomastia located beneath the nipple. The surgery should be extremely successful and easy to recover from. It is best to go to a surgeon who performs gynecomastia surgery frequently. Good luck.

Hi  thanks for your question. From your history and the photographs you have shared it looks like you have gynaecomastia. You will fall into the category of grade1 or mild gynaecomastia. Surgical excision of the gland as a day care procedure would be the option for you. Meet a board certified plastic surgeon for evaluation and further management.

Thank you for sharing your question and photographs.  Because of your current body habitus, as well as the 5 year duration of your appearance, I do think this is gynecomastia.  I would advocate speaking with an ASPS board certified plastic surgeon about direct glandular excision to cure the problem.  Hope this helps.