That's a tough one to answer Bojangles. I could put it simply and straight forward that as a customer of the NHS, they have a duty to ensure you are happy with the service they have given you. If you are not happy, then they have an obligation to put it right.
But as you already suspect it's not as simple as that. We are conditioned to believe that the NHS is 'free' but runs on a shoe-string budget. And because of this, we feel as if we should be grateful with what we are given and to never complain.
Are you due to return to your surgeon to check your progress? If that is so, then that is the time to give your views. It seems that the more I read about guys that had lipo only and no glandular excision, they are unhappy with the result. My surgeon makes a point of removing as much gland as possible each and every time. This is a guy with a high caseload of male chest procedures and arguably knows what he is doing.
My question is this, why do some surgeons give lipo only when there is glandular tissue present, glandular tissue that is responsible for some or most of the gynaecomastia in the first place?
Male chest reduction/sculpture is an increasingly recognised condition and it's my educated guess that this kind of surgery is going to increase in demand over the coming years. It's time plastic/breast/general surgeons got their heads together on this one to establish best practice!
Bojangles, if you do not have a follow-up appointment with your surgeon, telephone his or her secretary at the hospital and ask to speak with them in person by appointment. At four months post-op you will still be a patient of theirs. It's highly unlikely they will have discharged you yet, so you don't essentially have to go to your GP first. Tell them that whilst there is a difference, you feel as if you are still in the same psychological position as you were pre-surgery. Ask them why they decided not to excise the gland. Ask them if gland excision is something they do on some patients and not others because it possible that they are not experienced or knowledgeable enough to know how to deal with it!
There are other guys on this forum that had lipo only onto to return for gland excision at a later date (off the top of my head, markashleigh is one of them - he had surgery in Poland). Tell your surgeon that you know that surgical revision is common for those that had lipo only to in order to get the gland excised out.
Your GP and Surgeon have a duty of care to ensure your condition is treated with the best available resources. If your specific case is beyond the work of your current surgeon, then he or she has an obligation to hand you over to another surgeon that can deal with your problem.
It may seem daunting speaking with these guys, but if you are armed with the right information, be direct (but polite!) about your dissatisfaction and ask them what can be done about it then you have every chance of reaching your final goal. No right minded surgeon could ever expect to completely satisfy every patient every time. How else would they be able to learn and improve for future patients?
Hope that helps. Please keep us informed of your progress or if you get stuck.
Best wishes.