Unfortunately “puffy nipples” after gynecomastia surgery seems to be a common problem; it is mentioned frequently on the forums on this site and the popular website “Real Self.” It is imperative to choose a Board Certified Plastic Surgeon who specializes in gynecomastia surgery. Sculpting the chest with the right balance of remaining fat and breast tissue is an art and needs to be performed by an expert. If too much breast gland is removed a “crater deformity” will be the result. If too much gland is left behind the areola /nipple complex it will push outward and “puffy nipples” will be the result. In less experienced hands, some surgeons will try to reduce the male chest with liposuction alone which will not remove the breast gland. Other surgeons are very conservative in the surgical removal of breast tissue for fear of a “crater deformity.” In both cases, “puffy nipples” and “crater deformity” will require revision surgery for correction. Revision surgery for a “crater deformity” will involve fat grafts or a fat flap. Revision for “puffy nipples” will require additional excision which will be more complicated due to formed scar tissue from the original surgery. When choosing your gynecomastia revision surgeon, do your homework. Be sure your surgeon has experience in revision surgery; ask to see before and after pictures of patients who have had corrective surgery.