You've got so much gland tissue in there and so few posts that I originally thought your pics were a hoax.
I thought you were a girl. Then I looked at the size of your areolas and thought, no, too small to be a girl.
Take this the right way. You clearly have it. I don't know how that compression vest is holding those things in. Even at 6'5", you're a big dude at 350lbs.
I'm not convinced dropping weight will help because you have so much gland tissue in there, but I think it's a wise idea prior to surgery (for health reasons).