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

At 3 weeks post op you are still very swollen you have to give them time and let the swelling subside this can take 3-6 months so just be patient and continue to follow up with your PS.

Revisions are commonly needed many years after breast reduction.  Insurance companies do not usually cover this but it is worthwhile pursuing.  Many ASPS board certified plastic surgeons have certified accredited operating rooms in their offices which reduces cost significantly as...

Should easily be removed without impacting your axillary nodes... as you are not having a node dissection.  All your surgeon should be attempting to do is to make the contours better... not removal every bit of accessory tissue present, unless you want the tissue all gone.