What I can do to flatten/lighten my breast scars? (photo)

Thank you for your question. Breast incisions can be managed using a multimodal approach in the post-operative period:
1) Scar massage - starting as soon as the surgical dressings come off and the incisions are sealed
2) Silicone sheets or scar gels for about six months to year
3) Embrace - a tension reducing dressing for the first 2 months
4) Fractionated lasers to help blend the scar into the background - done as a series, starting about 4 weeks after surgery and repeated every four weeks for six months.
5) Sunscreen to prevent the scars from darkeningThis far out after surgery, I would recommend that you consider fractionated lasers.  With the darker skin tone, you may want to consider a radiofrequency procedure such as the Venus Viva.  I would also consider the use of steroids to help reduce the degree of scarring.  

You have hypertrophic scars. These can be treated with steroid injections, but bear in mind that they are not 100% successful and they have some local side effects that your doctor should warn you about. They are not the same steroids that can affect your body as a whole in any way, so you need not worry about that. They can help to soften and flatten the scars. However, the scars themselves are permanent and I trust you were appropriately informed of this prior to your surgery.

Injections/creams/IPL laser can "maybe" improve. But I ALWAYS explain to MY patients in their pre operatives informed consent session that there will be noticeable scars following a breast reduction. Maybe you missed this or it was never offered to you? 

Unfortunately you developed hypertrophic scaring. I would recommend steroid injection to help flatten the scar at this point and see if that improves the thickness of the scar. If that doesn't work then I would recommend  to have the scar revised, with  aggressive scar cream, taping and silicone sheeting after the scar is removed. Good Luck.

It seems that some of your scars are hypertrophic.  Steroid injections can soften, flatten, and lighten the scars.  It won't narrow the scars, only a scar revision could help possibly make the scars more narrow.  The injections usually need to be done 2 or 3 times.  Discuss this option with your surgeon, as well as the slight risks involved with steroid injections.  If they don't improve the scars to your satisfaction, a scar revision might be necessary. Close follow-up with silicone taping for 12 weeks may help the second time around, as well as injecting a small amount of steroid in any scar that seems to be beginning to get thick.

Early on after surgery there are several things I ask patients to do to help with scars--avoid sun, tape the incisions, perform scar massage, and consider silicone scar products.  I often will also laser the scars to help minimize their appearance. At a year after surgery, these methods are likely less effective.  You may want to go back to see your surgeon to discuss a scar revision where the old scar is removed and new one made; then get your surgeons' recommendations for how to care for the scar to prevent recurrence!  Part of scarring is just how we heal however, and even with great sewing and great scar care prominent scars can still occur. Good luck!

The 1540 fractional erbium laser can reduce pigment and flatten hypertrophic scars.  You will need at least for treatment scheduled a month apart.  Final results and improvement will be seen at 6 months to 12 months.  Steroid injections while they will reduce hypertrophic scars often cause fat atrophy which causes the scars to sink in and widen.