Uneven breasts - lateral displacement on one side. Do I need a revision or a possible capsulorrhaphy? (Photos)

Your right implant pocket is larger laterally and inferiorly, allowing the implant to migrate there, and making that breast's upper pole appear less than the other's. This can be corrected with a classic capsulorrhaphy, which is the placement of sutures with or without cautery. The addition of mesh may also entertained to make the repair more predictable and durable. The latter is known as an 'internal bra', but the goal is to achieve symmetry with the left breast and nothing more. As for rippling, your current implant is NOT highly cohesive, AKA gummy bears. The 'R' in your implants code SRF 415 stands for responsive, referring to the gel type. Responsive gel is the least cohesive gel, which was found in Natrelle's implants prior to the advent of the Inspira implants in 2013. Minimizing rippling for you should include an implant with highly cohesive gel, and preferably the highest cohesive gel possible. In the Inspira line that would be a SCF 415. In addition to gel cohesivity, shell fill is also important to minimizing rippling. Although Inspira implants are considered 100% filled, the new Motiva implants actually have a greater fill, and their gel and shell physical properties are matched for one another, creating much less rippling.

Thank you for your question. Capsulorrhaphy with or without Galaflex on the right side could be your best first step. It can tighten the stretched capsule on the right, reduce lateral movement, and provide a more lifted, centered position. Adjusting the left side is not advisable because it may become more challenging and increase the risk of bottoming out. Most surgeons prefer to match the tighter/higher side by tightening the looser side (as in your case, fix the right).The rippling is due to the thin breast tissue and implant behavior. You can consider switching to a different profile (Moderate Plus can sometimes help if the tissue is thin) or fat grafting.

There are many things happening in the photos including:
1) Inframammary fold malposition/instability
2) Visible implant rippling (related to the saline implant structure/thin tissues)
3) Long nipple to fold distance (due to stretching of the lower pole by the saline implant overtime)
I would recommend tightening the internal pocket/capsule (capsulorrhaphies), placing Galaflex for support, placing cohesive silicone gel implants. This is all just based on the photos. The plan may change after a history and physical exam with ultrasound in office.