New member, been trolling for about a year now.

[George Pope, M.D.]

I may have missed a point you made earlier on this thread, but why not just have the surgery?  You have obvious gynecomastia, it really bothers you, and your wife isn't really eager to see you start wearing a bra.  At your young age, you should do very well with standard surgery (liposuction and gland excision).  Your skin should contract nicely - you should get a great result.
Dr. Pope, MD