There are several factors that affect scarring. Unfortunately, the most important factor in scarring is out of anyone's control because it is your genetics. Some people heal well no matter what, and likewise, some people heal with terrible looking scars no matter what. You can look at other scars on your body to see how you tend to heal. That said, there are things you and your surgeon can do to minimize the appearance of scars after surgery.
What can your surgeon do?
1. Minimize the length of scars - This seems like a great idea, but making scars too short can limit the ability to really lift the breasts.
2. Keep tension off the skin - The tighter the closure, the worse the scar tends to look. Designing the surgical plan properly and avoiding a large implant (if one is used) helps. Also, using deep sutures to take the tension off the skin can help keep scars from widening or thickening after surgery. Finally, using tape strips to take the tension off the scars in the early weeks after surgery can be helpful.
3. Having good technique and using good sutures - Handling the tissue delicately and using suture with quality needles is important to avoiding tissue trauma and inflammation, which can impact the look of scars. It's hard to judge this directly as a patient, but a surgeon who is charging far less than others may be skimping on quality supplies or rushing during surgery. Reviewing before and after pictures can also help you get a sense of your surgeon's abilities.
What can you do?
1. Scar creams - Once be your incisions are healed, silicone based scar creams can be very effective, and silicone scar strips can be even more effective for reducing redness, keeping scars flat and narrow, and keeping them soft. These products have to be used regularly for at least 3 months to work though. There is a brand of scar strip that helps take tension off the wound called the Embrace. It is fairly pricey and cumbersome to use, but it can do a nice job of keeping the vertical scar narrow.
2. Avoid smoking - Smoking increases inflammation in the body and decreases delivery of oxygen and nutrients to the skin as it heals. Even a little smoking is bad since one puff of a cigarette can affect your skin circulation for several hours.
3. Follow your restrictions - Too much activity too soon or avoiding a supportive bra during recovery can affect healing.
4. Keep scars out of the sun - For a full year after surgery, you should keep your scars covered with clothing or sunscreen. Bathing suits do not have enough protection, so apply sunscreen under them.
5. Laser - I offer laser Genesis at my office. Once scars are healed, it can reduce discoloration and help flatten scars. Not everyone needs this, but it is fairly low risk and easy to tolerate if it is needed.