Why do my breast implants look "off"? (Photo)

You had some mild sagging which was not addressed and now have more sagging because of larger breasts. You can get a lift. I would suggest placing the implants behind the muscle for better upper breast fullness, avoiding seeing the implant edge, and more long term support for the implants.

I would personally recommend waiting a full year to let the implant settle. If you are still not happy with the shape you can have an implant exchange with a lift or just a lift in isolation. This is just based on the photos and a true plan can only be made with a real evaluation in person or on Zoom/Facetime.

This is a great question. There are many factors that go into a revision. In your case, there are a few things going on.
The implants you have are above the muscle, which may contribute to the look. Sometimes implants above the muscle can give unnatural results with rippling and the edge of the implants visible or palpable. It can also lead to breast or implants sagging over time, and can be malpositioned. One solution is to put the implant behind the muscle for a more subtle and natural result.
High projecting implants can also give an overly augmented look, even in smaller sized implants. Depending on how big or small you want to be, going down on the projection can also help contribute to a more natural look.
It appears that the nipples are pointing out (laterally). Sometimes, if there is a minor asymmetry or if the implant is placed too much towards the middle (medial) in order to get nice cleavage, it forces the nipples to point away. A solution to this would be to go slightly smaller with an implant. If you desire to maintain or keep your cleavage, you can consider getting a fat transfer to the inner part of your breasts to achieve that look without affecting the angle of your nipples.
Lastly, depending on what size you ultimately want to be after your surgery, you may need a breast lift. If you want to be smaller, then there may be extra skin that needs to be removed in order to place the nipples and areolas in the correct position.