A patient came in with a kind of "cheated twice" resignation. He'd had liposuction to treat his bromhidrosis — he'd heard it was small-wound, quick-recovery, no scar. Afterward the smell had barely improved, but the underarm had gained some palpable lumps and the skin surface was a little uneven. He was baffled: "Doesn't liposuction suck the stuff out? How is the smell still there, and now there are lumps too?"

I understand that confusion, because it touches on something very basic that often gets overlooked: what liposuction actually removes, and what it can't reach. So today let's talk about liposuction for bromhidrosis — why the smell so often doesn't improve, why it can leave lumps and unevenness, and where the difficulty lies in treating a liposuctioned underarm afterward.

Why liposuction for bromhidrosis often doesn't improve the smell

The bottom line first: because liposuction removes fat, and the apocrine glands that actually make the smell don't live in the fat layer.

Underarm smell comes from the apocrine glands, and these are distributed mainly around the junction of the dermis and the subcutaneous tissue — right up against the skin. Liposuction works by using a cannula to suck away the fat under the skin; what it takes is that fat layer. The odor-producing glands aren't in that fat — they sit closer to the skin. So liposuction removes the fat but struggles to genuinely reach the apocrine glands pressed against the skin. The source of the smell is still there, and so, of course, is the smell.

That's why so many people feel there's "not much difference" afterward. It isn't that your situation is especially hard — it's that this method has trouble reaching the very place that needs treating.

What else liposuction can leave: fibrotic lumps and unevenness

What's more troublesome is that liposuction isn't only "ineffective" — some people are left with extra problems.

The cannula passing back and forth under the skin is itself a form of trauma. The underarm is a small area that also moves a lot, so if the suction is on the rougher side, the subcutaneous tissue can develop fibrosis as it heals — which feels like knots of hard tissue, sometimes stuck to the skin, leaving the surface looking uneven. So some people not only fail to resolve the smell but also take on two new troubles: lumps and an uneven contour.

Why re-clearing the glands in a liposuctioned underarm is a difficult operation

So can the apocrine glands still be cleared? Yes — but honestly, re-clearing a liposuctioned underarm is a fairly difficult salvage operation.

The reason is that the fibrosis and adhesions from liposuction blur what were once clear tissue planes. In a normal, un-operated underarm the layers are relatively clean, and finding the apocrine glands and judging how far to clear is easier to control. But in a liposuctioned, fibrotic underarm, lumps, scar, and adhesions are mixed together, and finding the glands that were never reached in the first place and clearing them clean — while also dealing with the lumps and unevenness — is considerably harder.

And the balance from the earlier pieces still applies: this kind of underarm skin has already been through something, so clearing has to judge more carefully between "cleared enough" and "keeping healthy skin." How I actually read through the fibrosis and clear it is something I decide region by region on the operating table, and it's hard to pin to a single sentence.

Can this situation still be salvaged?

Yes. I've seen patients who had liposuction for bromhidrosis with no improvement in the smell at all, left with severe fibrotic lumps and an uneven underarm — and in the end I still cleared their apocrine glands and addressed the lumps, freeing them from the trouble.

To be clear, though: a liposuctioned underarm is a difficult salvage case; everyone's degree of fibrosis, how many glands are left, and the state of the skin all differ, so I always speak of results as "greatly improved," varying from person to person. Nor will I criticize whoever did your liposuction; what I look at is the state of the underarm now, how I can help clear it clean, and improve the unevenness.

Common questions

Doesn't liposuction suck the problem out? Why is the bromhidrosis smell still there?

Because liposuction removes fat, and the apocrine glands that make the smell don't live in the fat layer. They sit mainly around the junction of the dermis and the subcutaneous tissue, right up against the skin. A cannula takes away the fat under the skin but struggles to reach glands pressed against it, so the source of the smell remains, and so does the smell. When people feel there's "not much difference" afterward, it's usually because the method has trouble reaching the glands, not because their situation is especially hard.

After liposuction I can feel hard knots in my underarm and the skin is uneven. Where did that come from?

The cannula passing back and forth under the skin is itself a form of trauma. The underarm is a small area that moves a lot, so if the suction is on the rougher side, the subcutaneous tissue can develop fibrosis as it heals. That feels like knots of hard tissue, sometimes stuck to the skin, leaving the surface looking uneven. So some people end up with lumps and an uneven contour on top of the smell they still have.

Can the glands still be cleared in a liposuctioned underarm? Is it harder?

They can, but honestly, it's a fairly difficult salvage operation. Fibrosis and adhesions from liposuction blur what were once clear tissue planes; lumps, scar and adhesions are mixed together, and finding the glands that were never reached and clearing them is considerably harder than in an underarm that hasn't been operated on. How to read through the fibrosis and how far to clear is something I decide region by region on the operating table.

Can the lumps and unevenness be dealt with at the same time as the glands?

Often they can be addressed in the same operation, though how much the lumps and contour improve varies from person to person. Because this skin has already been through something, clearing has to judge more carefully between "cleared enough" and "keeping healthy skin," rather than focusing on clearing alone.

How much can surgery help after liposuction?

A liposuctioned underarm is a difficult salvage case. The degree of fibrosis, how many glands are left, and the state of the skin differ for everyone, so I always describe the result as "greatly improved," varying from person to person. The practical first step is an in-person assessment to see how many glands remain and how severe the fibrosis and unevenness are, and then decide together how to clear and how to repair.

If you've already had liposuction and still smell

Don't conclude you're beyond help, and don't be quick to blame yourself for choosing wrong. Liposuction for bromhidrosis not improving the smell is often because the method has trouble reaching the glands in the first place — not because your constitution is especially difficult.

The practical step is to come in for an in-person assessment first, look clearly at how many apocrine glands are still left in the underarm and how severe the fibrosis and unevenness are, and then decide together how to clear and repair. If you'd first like to understand the whole picture — what bromhidrosis actually is and how it should be treated — our sister site has a full guide worth reading: The complete guide to bromhidrosis: causes, assessment, and treatment options.

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