Are my nipples messed up or is this normal at almost 4 weeks post op? Why is my skin rippled at the bottom? (Photo)

Well, I agree that the nipples need to be centered.  While it will require an operation, this can be relatively easily fixed.  As for the results, I do not do vertical lifts for the reason of the shape of breast that you have after surgery.  Good luck with your revision.

I'm sorry to hear that you've had a less than desirable result.  There is certainly some asymmetries and lack of roundness to the nipples and excess tissue.  This could be easily revised without a great amount of recovery.  I'd recommend a Weiss pattern or anchor pattern lift to removed the excess tissue.  Talk to your surgeon about your concerns and consider getting a second opinion on operative plan.  Best wishes.

Augmentation mastopexy incisions and shapes can take a while to look normal. Hang in there! As long as the shape and feel are improving week to week, however slowly, there is still hope for the final outcome. Ask you plastic surgeon if there are any compression garments, stretches or massaging exercises that can help speed your recovery.