Can my misplaced areola complex be moved down? How extensive is the surgery and is skin grafting required? (photos)

Your nipple location is probably okay but looks high because the breast tissue bottomed out. You need the size of your breasts reduced and the skin in the lower portion tightened. Trying to lower the nipple will be difficult and leave you with unsightly scarring.

You appear to have undergone a circumvertical breast lift.  This frequently results in bottoming out that you are experiencing.  You will need a revision of the breast lift.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.Best Wishes,Gary Horndeski, M.D.

Dear Knoodledge,
It is hard to tell for sure without an examination, but based on your photos, it looks like you would benefit from breast lift revision surgery.
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