Should I be concerned that my breasts are not aligned? Also my nipples feel large and puffy 2 weeks post reduction. (photos)

At 2 weeks it is still very early to see final results, give it at least 3-6 months for your breast to heal and settle, continue to follow up with your PS to discuss your concerns.

At 2 weeks after surgery, it is still far too early to try and assess the final result. No two breasts are the same before surgery, and as a result your breasts can respond slightly different to surgery (different amounts of swelling etc). Typically it takes 3-6 months to determine the final result from this trip of surgery, so patience will be the most important thing for now

Ar 2 weeks, it is much to early to judge the results. Give it at least 3 months to let everything settle down, then assess.