Scar tissue from Gynecomastia surgery

Thank you for sharing your question and photograph and I am sorry that your current results have not been what you anticipated.  Only an in-person examination can offer you the best treatment advice but it appears that you may have excess adipose tissue (pseudogynecomastia) that is causing your chest asymmetry.  This can be improved but would require an additional surgery with liposuction to better contour both chests.  Hope this helps.

Based on your photos, it appears that yes, you will need some form of revision surgery to even out your results. I am surprised that your original surgeon didn't perform liposuction. I would encourage you to get an in person opinion from a different board certified plastic surgeon who specializes in gynecomastia revisions. Given how fit you are, you should be able to achieve a much more ideal result. Best of luck.

Your concerns with your result are well noted.  I usually let my patients know that, after about a year post-op, the result that they have is the result they will continue to have.  As you are 18 months out in this case, I would say that the best way to improve your result is with a revision surgery.  This will likely involve liposuction of the chest, and may involve a small amount of skin removal above the nipple to elevate it to a position that is more desirable.  In cases like this, I always encourage patients to revisit their initial surgeon first.  If this is not a possibility, or you desire a second opinion, I would encourage you to visit a board certified plastic surgeon who is experienced in gynecomastia surgery.