Axillary hyperhidrosis, commonly known as excessive underarm sweating, is a common problem. It usually starts during puberty and persists for the rest of the life. In addition to staining clothes, the sweaty odor can be quite embarrassing during social interactions.
Normally, underarm sweating is alleviated with antiperspirants that are available over-the-counter as well as with prescription. Surgery is used only when the standard non-surgical procedures could not produce the desired result. The surgical procedure commonly used for treating problems of underarm sweating is called endoscopic thoracic sympathectomy.
Newer procedures using laser are also effective in alleviating abnormal sweating of the underarm. However, surgery for underarm sweating can cause adverse reactions. Therefore, before opting for the process, make sure that its benefit outweighs its risks.
Surgery For Underarm Sweating
Endoscopic Thoracic Sympathectomy (ETS)
ETS is a surgical procedure that destroys a portion of the sympathetic nerve that transmits the sweating signals from the brain to the sweat glands. The procedure is performed under general anesthesia. During the procedure, an endoscope or small camera is inserted into the chest through an incision below the armpit. The lung on the side where the surgery is being performed is deflated to enable the surgeon to work easily.
Through another incision, small tools are inserted into the chest with which the nerves that transmit the sweat impulses to the armpit are destroyed or cut. After removing the surgical tools and the endoscope, the lung is then inflated. The cuts are then closed with stitches. To facilitate drainage of pus or fluid from the chest following the surgery, your surgeon may leave a drainage tube in the chest for a day. The procedure is then repeated on the nerve that triggers sweating in the other underarm. It usually takes one to three hours to complete the surgery.
What To Do Before The Surgery
For a few days before the scheduled surgery, you doctor may ask you to stop taking anticoagulant drugs, non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin and vitamin E supplements.
By thinning the blood, these medications increase the risk of bleeding during the surgery. You should also stop smoking before the surgery.
What To Do After The Surgery
After the surgery, most patients remain under medical supervision for a day in the hospital. To reduce the pain that is likely to persist for a week after the surgery, your doctor may prescribe a pain relief medication. The surgical cuts should be kept clean and dry. They should be covered with a clean bandage. The dressings should be changed according to your doctor’s instruction. After a few weeks, you can resume your normal activities.
Side Effects Of Surgery
Damage to the nerves or arteries, hemothorax or accumulation of blood in the chest, new sweating, excess sweating in other parts, also known as compensatory sweating, drooping of eyelids and reduced facial sweating are other possible side effects of the surgery. It may even cause breathing problems, bleeding, stroke or heart attack, infection and allergic reactions.
Laser Sweat Ablation (LSA)
Laser sweat ablation, also known as AxiLase, is a newer surgical treatment for underarm sweating. It has several advantages over ETS. In more than 70 percent people, it offers complete relief from underarm sweating.
This procedure is performed under local anesthesia. Hospitalization is not required for the treatment. With the help of an iodine test, the sweating areas in the armpit are marked.
After numbing the area to be treated with an anesthetic injection, one to two cuts are made on each side of the armpit. A laser beam is then fired to the targeted area through the incision to destroy the sweat glands, which are then removed from the armpit by suction. The incisions are covered with a bandage.
After The Procedure
Just as in the case of ETS, similar precautions are needed for preventing infections and speeding healing following laser sweat ablation. The wounds usually heal within a week. Within two weeks, you can resume your routine activities.
LSA is usually considered safe. However, since it is a new procedure, further studies are needed to identify its possible long-term risks.
Retrodermal curettage surgery involves removal of the sweat glands from the armpit area. This is one of the new and effective forms of surgery for treating underarm sweating. It has a high success rate when performed by an experienced surgeon.
Retrodermal Curettage is usually done under local anesthesia. The surgeon makes an incision underneath the armpit and with a specialized tool performs curettage to remove the sweat gland from the area.
An antibiotic solution is then applied to the treated area, which is then covered with a bandage.
After The Procedure
You can leave the clinic a few hours after the surgery. Precautions should be taken to prevent infection. The surgical dressing is usually removed within 48 hours. Although you can resume your daily activities within a few days, exercises are not allowed for a month.
Mild scarring due to skin loss is a common side effect of retrodermal curettage. Small fibrotic bands may develop after the surgery. Usually it disappears within a few months. Mild discoloration of the underarm skin is another side effect of the procedure.
Liposuction is a popular cosmetic surgery procedure used for treating excessive underarm sweating. It is considered safe. As tiny incision is needed for the procedure, there is minimal risk of infection. Moreover, unlike ETS, liposuction does not cause compensatory sweating or excessive sweating in other parts of the body.
In this procedure, a fine suction cannula, similar to the ones used for liposuction processes, is inserted into the tiny incision made under the armpit to remove the sweat glands.
Antibiotic medication is applied to the incision to protect the treated area from infection. The cut heals rapidly, and within a few days, you can undertake your normal activities.
In a small number of cases, a second liposuction procedure is needed to provide long-term relief from underarm sweating. Discomfort, swelling and bruising are minor side effects of the procedure that heal within a few days. Liposuction may cause mild scarring.