6 weeks post op, why are my nipples still puffy? (photos)

Overall your breasts look very nice, and the implants are well positioned.  With a periareolar incision and correction of a tuberous breast deformity, it is common to look puffy while the breasts are still swollen. I would wait several months.  Some patients benefit from a second periareolar correction which can easily be done in the office, because part of the problem with tuberous breasts are puffy breast tissue around the areola, which cannot always be completely corrected with one procedure.  I would be patient and see how things progress. 

"Puffy nipples" can persist for several weeks/months after breast augmentation and are often a part of tuberous breast deformity.  I would give things a full 3 months after surgery to settle down.  If you are still concerned, discuss it with your PS.