Surgery for underarm sweating is outdated, however maybe a last line resort, only if you have sweaty hands associated with underarm sweating. In the 1980s surgeons use to excise the skin and sweat glands from the underarms. In the late 1990s, liposuction was used. This was replaced by laser liposuction, then sweat stopping treatments, and now miraDry. Unlike surgery, miradDry does not involve cuts or incisions and is considered to be a non-invasive, low risk but permanent procedure.
Facts on surgery for underarm sweating
- 3-4 % of the Australian population suffers from excessive sweating
- Surgery, unlike sweat stopping treatments can provide a permanent solution for the treatment of underarm sweating
- Surgery should only be considered if underarm sweating is associated with sweaty hands
- The only type of surgery used now a days is called ETS or endoscopic thoracic sympactectomy
- This involves the destruction of nerves that inputs the sweat glands
- Once performed sweat gland surgery is permanent
- ETS is most useful if sweaty hands are associated with sweaty underarms
- Complications such as compensatory sweating can occur following ETS surgery
- miraDry has replaced invasive surgery for the treatment of underarm sweating
When should I consider surgery?
Surgery for underarm sweating should now be historical, as non-invasive, permanent and safe procedures such as miraDry have been approved by the FDA (US), European and TGA (Australian) health safety boards.
Consider surgery if:
- You have sweaty hands
- You fail treatments such as glycopyrolate iontophoresis
- You can understand the risks of surgery including compensatory sweating, partial improvement, risks of bleeding, infection and Horner’s syndrome.
- Side effects such as rebound sweating are impossible to predict and maybe permanent.
More on ETS Surgery for sweating
What is compensatory or rebound sweating?
This form of sweating ‘compensates’ for the lack of sweating elsewhere. Compensatory hyperhidrosis can occur in up to 50% of patients following ETS surgery. It is more commonly seen if BOTH sweaty hands and sweaty underarm ETS is performed. Compensatory sweating may occur in areas such as the face, chest, back, and abdomen. The extent, severity and location is impossible to predict. Advancements in surgery over the years have reduced the incidence of ETS, however rebound sweating is still a feared side effect.
Are there non-surgical treatments for underarm surgery that are effective?
Yes. Sweat stopping treatments and miradry. Each form of treatment has advantages and disadvantages. The type of treatment that suits you really depends on whether you want a short term gain (sweat stopping treatments), or require a permanent, life-long fix for your problem. This usually boils down to the cost of each treatment. As a guide, see the sweat table solution below.
|Type of treatment||sweat stopping treatments||Miradry|
|Duration of sweat reduction||2-8 months. Average of 6 months||Permanent|
|Cost||Spaced as needed||2 treatments, 3 mths apart|
|Great treatment for underarms, especially if it can last 6 months or longer.||Permanent sweat reduction after 2 sessions. Initial cost will be saved over 2-3 years|
Who should I see if I am contemplating surgery to treat my sweating?
This is a big step for you if surgery is planned. Ask your GP to refer you to a vascular surgeon is the first step. You have to be well informed of the risks of surgery, as well as rebound-compensatory sweating.
As a rule, vascular surgeons will not perform surgery for underarm sweating, but may consider this treatment for sweaty hands.
Are there any advantages of surgery over other treatments to treat my sweating?
Yes. If you suffer from sweaty hands and sweaty underarms, surgery maybe indicated. Recovery from ETS sweat surgery is usually uneventful and quick, and if successful, this treatment is permanent. Remember, side effects such as compensatory sweating cannot be predicted with ETS sweat surgery.
Specialist’s perspective on surgery for underarm sweating
Dr Davin S. Lim
The age of surgery for treating sweaty underarms has been and gone. Without doubt, miradry is safer and more effective in reducing underarm sweating than excision of the underarm skin. Liposuction of the eccrine glands was the trend over a decade ago. Sweat stopping treatments followed in FDA approval in 2007 and is widely used by Specialists in Australia. Sweat stopping treatmentsstill remains the treatment of choice for many patients as it is cost effective and effective in up to 95% of cases. Sweat stopping treatments need to be repeated every 2-8 months to remain effective. miradry however, is permanent.
Where does surgery fit into the picture of sweat treatments? The answer is if you have sweaty hands (possibly associated with sweaty underarms). You may want to consider glyco. Iontophoresis as a treatment, or if you are willing to take the risk of compensatory sweating, surgery maybe for you. A through discussion with your vascular surgeon is needed prior to making this life changing event.