I can only think money. If I had that shit, I would pay the 2 grand immediately.
Double that figure if you're going to a good surgeon. You are right though, it's a cost prohibitive procedure. And it'll keep you out of the gym for a few weeks, maybe as much as a month or two before you're training hard again. Considering how most people rocking gyno have aggravated it with AAS use, I'm guessing they fear lost gains as well.
I had a bit of a puffy nipple but thankfully it subsided. I actually can't see it anymore. When nipples get puffy, people should use proper ancillaries to make sure it doesn't get hard and become permanent. I've seen people with rock hard gyno knock it down in appearance with some letro. I'd rather pay $100 for letro than $4000+ for gyno surgery. Must suck having a great physique and not be able to take your shirt off. Sometimes it just can't be helped and needs to get cut out though.