Medial Implant rippling immediately after surgery with right nipple pointing laterally (photos)

I started using the subfascial technique almost 10 years ago and early on realized that medial coverage was not always optimal so I then developed the split muscle technique, which preserves muscle coverage medially and on the upper part but avoids many of the issues with under muscle implants such as animation. Your implants appear on the large side so the base diameter might be pushing the limits, which can also cause thinning of the tissues around the implant. Nipple position is a pre-existing anatomic feature, so if the implants were centered under the nipples when they are relatively lateral then there could be too much space between the breasts. Your options at this point are: fat transfers, acellular matrix such as Strattice, mesh reinforcement with SERI Scaffold or GalaFLEX, or back to under muscle using the split technique.

I am not sure why you would have wanted to move your implants from below the muscle to over the muscle. But you are experiencing one of the problems often seen with such a decision. There is much less tissue coverage over your implants now and your implants will be more palpable and likely to show rippling. The implant pocket has also been over-dissected medially and your implants are no longer centered behind your nipple and areolae. This, unfortunately is not going to get better without another surgery and will probably get worse. I would suggest putting your implants back under the muscle and having a medial capsulorrhaphy procedure to prevent the medial migration of the implants.  

The medialization of your implants may be due to pocket adjustments or too large an implant, but this may not improve the nipple position significantly.  As for the rippling, it is probably related to the thickness of the tissue and may be improved by using Strattice or fat grafts.