Is it time and what are my best options?

Good morning!Sounds like it's revision time- I would recommend a donut mastopexy to lift your nipple position and tighten your skin, the Internal Bra to tighten and lift and support your implant pockets, and new implants with better projection!

Dear LLRD35,
based on your photos, it looks like you will need a revision surgery in order to get good results. You will probably need a breast lift and implant exchange.  My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. 
If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery