What are puffy nipples exactly?

[spooon]

Is it a less severe and/or early stage of gyno where only the nipple itself protrudes/is swollen?
Is it a soft areola that feels squishy and craters on touching?
If it's the latter why how does that square with fact breast tissue is supposed to be hard?

[Dr. Elliot Jacobs]

Puffy nipples are caused only by breast tissue, not fat, which is concentrated under the areolas.  One cannot diagnose by feeling -- oftentimes breast tissue (gland) feels as soft as fat does.

The diagnosis is made by observation.  If the areola protrudes (like a cone or dome) above the level of the surrounding skin, then it is by definition a puffy nipple which is caused by breast tissue.

Puffy nipples can exist alone on a very thin/skinny guy, or it can be found on chests which have additional excess tissue (fat and gland).  All of these different types are called "gynecomastia."

Many surgeons think that treatment of puffy nipples is simple -- just cut out the excess tissue until the nipples lie flat.  This cavalier approach often leads to post-op crater deformities.  That is why a consult with a gyne specialist is so very important.

Dr Jacobs