Effect of Topical Timolol on Healing of Immature Breast Scars After Mammoplasty: A Randomized Controlled Trial With Blinded Assessors and Patients

Abstract

Introduction: Wound healing is a complex process encompassing four main stages: hemostasis, inflammation, cell proliferation, maturation, and differentiation. Timolol (TM) may influence these stages, particularly re-epithelialization. This study aims to evaluate the 1-month effects of timolol on acute surgical wounds in post-mammoplasty patients.

Objectives: To investigate the efficacy of topical timolol in improving postoperative breast scars, aiming to guide future treatment protocols and prescriptions.

Methods: A total of 12 patients who underwent bilateral mammoplasty were enrolled in this double-blind randomized clinical trial. Treatment commenced 48 h post-surgery; one breast was treated with 0.5% timolol eye drops, while the contralateral breast received distilled water (control). Patients were advised to minimize sun exposure and pressure on the treated area, and no additional oral or topical medications were prescribed. Cleansing with a prescribed cleanser occurred every 3 days. Cosmetic assessments were conducted by a specialist at 10 and 30 days post-surgery using a 10-point Likert scale. Data were analyzed using two-way repeated measures ANOVA.

Results: Timolol significantly reduced erythema over time (Interaction, p < 0.0001; Treatment, p = 0.02), with an average decrease of 5.38 points (95% CI: 4.22-6.55) compared to 4.41 points (95% CI: 3.83-5) for placebo. The difference in reduction was 0.972 points (95% CI: 0.18-1.7). A significant improvement in the aesthetic appearance of the breast was also noted (Interaction, p < 0.0001; Treatment, p = 0.015), with timolol enhancing the aesthetic score by approximately 5.5 points (95% CI: 4.9-6.2) versus 4.58 points (95% CI: 3.4-5.7) for the placebo. Overall, timolol improved the aesthetic score by 0.972 points (95% CI: 0.23-1.7) more than the placebo.

Conclusion: Topical application of 0.5% timolol significantly improved the aesthetic appearance and reduced erythema of post-mammoplasty breast scars over a 1-month period. The results demonstrate a measurable clinical benefit, with statistically significant differences favoring timolol over placebo. These findings suggest that early intervention with topical timolol may offer a safe, effective, and non-invasive option for optimizing scar outcomes in surgical patients.

Keywords: RCT; clinical trial; immature scar; mammoplasty; postoperative scar; scar; timolol; topical timolol; wound.

FIGURE 1

Ten‐point Likert scale.

FIGURE 2

Comparison of the effectiveness of topical timolol versus placebo in reducing breast scar erythema.

FIGURE 3

Comparison of erythema and aesthetic appearance between the timolol group and the control group. (A) Before intervention (2 days post‐surgery); (B) 10 days post distilled water; (C) 28 days post distilled water (30 days post‐surgery); (D) Before intervention; (E) 2 days post topical timolol; (F) 28 days post topical timolol.

FIGURE 4

Comparison of erythema and aesthetic appearance between the timolol group and the control group. (A) Before intervention (2 days post‐surgery); (B) 10 days post distilled water; (C) 28 days post distilled water (30 days post‐surgery); (D) Before intervention; (E) 2 days post topical timolol; (F) 28 days post topical timolol.

FIGURE 5

Effectiveness of topical timolol compared to placebo in improving the aesthetic appearance of breast scars.