**Background:** Bromhidrosis is a condition characterized by excessive or abnormally foul-smelling axillary odor, often exacerbated by poor hygiene, diabetes, intertrigo, erythrasma, or high BMI. While noninvasive treatments (topical agents, botulinum toxin, laser, microwave) offer only temporary relief, suction-curettage has emerged as a safe, minimally invasive surgical option with low complication rates and rapid recovery. However, high efficacy can be associated with complications such as subcutaneous hematoma, wound necrosis, and delayed healing, which increase the risk of hypertrophic scarring. Prior to this study, no literature had systematically examined factors affecting complications in suction-curettage for bromhidrosis.
**Methods:** This retrospective study evaluated 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019 at Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan. All procedures were performed under local anesthesia by 9 surgeons. Cases with less than 1 year of follow-up were excluded. Surgical technique involved shaving axillary hair, marking the hairline plus 1 cm beyond, and injecting either 40 mL of 1% lidocaine or tumescent solution (300–600 mL). A 1 cm stab incision was made, and an arthroscopic shaver performed suction-curettage at 1500 rpm and 250 mm Hg for 7–15 minutes. Dressing methods varied by surgeon and included fibrin sealant (ARTISS), anchoring sutures, drains, and compression dressings for 1 or 3 days. Complications (hematoma/seroma, epidermis decortication, skin necrosis, infection) were recorded at 1, 3, 6, and 12 months. Scarring was graded using the Vancouver Scar Scale (minimal: 0–1, mild: 2–4, severe: ≥5). Multinomial logistic regression was used to calculate odds ratios and 95% confidence intervals, adjusting for statistically significant variables.
**Key Results:** The cohort comprised 160 women (74.42%) and 55 men (25.58%), with a mean age of 25.65 ± 22.0 years (range 12–67). Efficacy was excellent in 382 axillae (88.84%), good in 36 (8.37%), and failed in 12 (2.79%); 11 of the 12 failed axillae underwent secondary suction-curettage with excellent results. Overall complications occurred in 52 axillae (12.09%). Epidermis decortication occurred in 24 axillae (5.58%) and was significantly associated with older age (adjusted OR 1.11; 95% CI 1.07–1.16; P < 0.001). Fibrin sealant plus 1-day compression dressing was associated with a higher risk of epidermis decortication compared to 3-day compression alone (adjusted OR 66.22; 95% CI 2.41–1821.97; P = 0.013). Hematoma occurred in 10 axillae (2.33%) and was significantly associated with not using tumescent infiltration (P = 0.039); no hematoma occurred in the tumescent group. Shaving time showed a significant difference in the chi-square test (P = 0.013) but not in adjusted analysis (P = 0.101). Skin necrosis occurred in 16 axillae (3.72%) and was significantly associated with older age (adjusted OR 1.07; 95% CI 1.03–1.11; P = 0.001) and, paradoxically, with tumescent infiltration use (adjusted OR 18.62; 95% CI 1.32–263.21; P = 0.030). Infection occurred in only 2 axillae (0.47%) with no significant predictors. Ten axillae (2.33%) with skin necrosis or infection required secondary debridement and closure. Scarring was severe in 15 axillae (3.49%), mild in 48 (11.16%), and minimal in 367 (85.35%). Patients with postoperative complications had significantly more severe scarring (P < 0.001), except for those with hematoma. No patient experienced limited range of motion after massage.
**Clinical Implications:** This study identifies older age as a consistent risk factor for epidermis decortication and skin necrosis after suction-curettage for bromhidrosis, likely due to age-related dermal thinning. Tumescent infiltration effectively prevents hematoma and improves postoperative pain control, but its association with increased skin necrosis risk warrants caution—possibly due to tissue edema obscuring the endpoint of curettage. Compression dressing for 3 days appears sufficient and cost-effective, while fibrin sealant offers similar outcomes at higher cost. The overall complication rate of 12% is acceptable given the high efficacy (88.84% excellent results). Surgeons should carefully determine the endpoint of curettage in older patients and consider tumescent infiltration for hematoma prevention while monitoring for skin necrosis. Postoperative scar massage is effective in preventing motion limitation.