Operated Several Times and Still Smell: Re-Clearing Residual Apocrine Glands, and How to Judge Repeat Revision Surgery

I remember it clearly: one patient came in almost in a "one last try" frame of mind. He'd been operated on several times elsewhere, seen different doctors, had several rounds of rotational curettage, and each time was told it was a "recurrence" and that he needed another round. In the end the smell was still there and he'd nearly lost heart. He asked me: "Is my kind just untreatable?"

I've seen plenty of patients like this. What I want to talk about today is exactly that: why some people are "operated several times and still smell," whether it's really a matter of constitution, and — when residual apocrine glands need re-clearing — how that's judged and where the difficulty lies.

"Smell came back" isn't necessarily recurrence — often it's just never cleared clean

Start with a key distinction. The moment the smell returns, the instinct is "it's come back." But from the surgical side, the more common situation I see is this: it isn't that the glands grew back — it's that a batch of apocrine glands was never reached the first time and has been working there all along.

The two sound alike, but they call for different directions. Whether it's a true recurrence or the original residue, and how to tell them apart, our sister site covers clearly from the odor angle: Smell back after bromhidrosis surgery — true recurrence, or never cleared clean?. What I want to carry on to here is this: if it's confirmed to be residue, how do you re-clear it surgically?

Why does residue happen, and what does re-clearing face?

Residue usually comes back to whether the first operation cleared thoroughly enough: the area wasn't cleared wide enough, the edges and corners were missed, or the wound was closed before careful confirmation — any of these leaves behind a batch of glands still producing smell.

The trouble is that re-operating on an already-operated underarm is harder than the first time. The first surgery has already been through that layer of skin, leaving scar tissue and adhesions, and the skin may already have been cleared fairly thin. Re-clearing now means finding and removing the remaining glands in an environment that's already been operated on, where the planes have become blurred — a different matter altogether from a clean first operation.

And don't forget the balance from the last piece: skin that's been operated on once is already on the thin side, so re-clearing has to be even more careful. You can't, in pursuit of "this time it's definitely coming out clean," clear the skin too thin again — the price for that is breakdown and poor healing. So re-clearing leans even harder on judging the balance between "cleared enough" and "keeping enough healthy skin."

An underarm operated on several times — can it still be treated?

Yes. Back to that patient at the start who'd been operated on several times: I did go on to clear his residual glands, and the smell improved greatly. I've also seen people operated on five times by different doctors without resolution, finally cleared here.

Let me be honest about two things. First, cases operated on multiple times are the more difficult salvage kind — not every one is as straightforward as a first operation — but most can be worked on again to clear the residue. Second, I won't use language like "guaranteed cure." I always speak of results as "cleared close to clean, greatly improved," because everyone's prior handling, how much is left, and how thin the skin already is all differ, so results vary from person to person by nature. Nor will I pass judgment on the doctor who operated on you before; what I look at is what's still left inside the underarm now, and how I can help clear it clean.

How I judge and carry out re-clearing

Plainly put, the order for re-clearing follows the same spirit as the first operation — just more cautious.

First look clearly at what's still left and where the residue is concentrated, rather than rushing into another operation. Once that's clear, re-clear the areas that still have glands — again clearing the area wide enough and confirming nothing's missed before closing the wound. The difference is that in a previously operated site the planes are blurred and the skin is on the thin side, so every step has to judge the balance between "clearing clean" and "keeping healthy skin" more carefully. As for how I actually read through the scar and adhesions and decide how far to clear, that's something I decide region by region on the operating table, and it's hard to pin to a single sentence.

Don't decide you're untreatable just because it failed before

What I most want to say to those who've been operated on several times and are ready to give up is this: the smell still being there usually doesn't mean your constitution is especially hard to treat. Far more often it means it was never cleared clean and there's residue left. That situation can often be worked on again.

If you've also had surgery and still smell, don't be quick to conclude you're beyond help. You can come in for an in-person assessment first, look clearly at what's still left inside the underarm and where the residue sits, and then decide together whether — and how — to re-clear. To first understand whether yours is a true recurrence or the original residue, the sister-site identification piece above is worth a read.

This article is educational. Individual situations require in-person consultation; actual treatment and results vary from person to person.