Hi hidden916 and welcome to gyne.org.
You touched on the main issues when it comes to gyne. Some guys are simply too heavy and that fat can make their chests bigger. We've all seen this...the fat guys at the pool whose boobs were noticeably big? But they didn't really look like a girl's chest....they just looked fat. Sometimes you'll hear this referred to a "pseudo" (or false) gynecomastia, because the growth is due to the extra weight and not stimulated tissue underneath the breast. Many men who have this kind of chest will be fairly satisfied with the way they look by losing the weight. If not, they can have it lipo-suctioned away.
Then, of course, there is the classic gynecomastia where the tissue underneath the breast actually starts to grow and the breasts literally start to take on a female appearance. This increased tissue, along with fat, are the things that are causing all the problems for everyone here. It is precisely these things that are targeted during gyne surgery.
Surgeons excise the increased tissue under the breast through a small incision at the base of the areola, and then they make the contour of the breast look as natural as possible by sucking excess fat out of the breast via liposuction. The doctors here say ALL men have a combination of fat and at least some tissue, but whether or not that tissue needs to physically be excised just depends on the individual case.
If you can, try to post some pictures of your chest to give us an indication of what you're dealing with. We have several doctors here that do the surgery and they will occasionally give their input as to what they think you need.
The usual place to start to get the ball rolling is with your primary care physician. He/she may want to do some hormone tests, or they may send you to an endocrinologist to get them done. This is simply to make sure that there is not a physical reason for your breast growth that can be medically controlled.
After you've been through all this preliminary stuff (yes, we all have to go through it), then your primary doc should be able to refer you to a board certified plastic surgeon to get the situation corrected. When looking for a surgeon, you want one who preferably specializes in gynecomastia surgery. If you can't get one that specializes in this type of surgery, at least find one who has a wealth of experience at gyne surgery; someone who performs many of them each year. When choosing a surgeon, ask to see their before/after pics, because you want to seen an indication of their work. In all probability, what you see in those pictures will be what YOU receive. So choose "quality" first, and don't automatically go with whatever doc is cheapest; you don't want to scrimp on your body and health. The best chance to have the results you want from surgery are with the FIRST (and hopefully last) surgery, so choosing a competent/qualified surgeon is of utmost importance.
