Effectiveness and Safety of Suction-Curettage Surgery for Axillary Bromhidrosis: A Prospective Cohort Study

BACKGROUND: Axillary bromhidrosis, caused by apocrine gland secretions, leads to substantial psychosocial burden. This study aimed to compare the efficacy and safety of suction-curettage surgery versus small-incision direct-vision trimming surgery for moderate-to-severe cases. METHODS: In this prospective cohort study, 196 patients (Park-Shin grades 2-3) underwent suction-curettage (n=96) or small-incision surgery (n=100). Primary outcomes included 6-month cure rates and postoperative complications (necrosis, pigmentation, infection, hematoma, recrudesce). Secondary outcomes encompassed healing time and Patient/Observer Scar Assessment Scale (POSAS) scores. Propensity score matching (PSM) balanced baseline confounders; multivariable analysis identified risk factors. RESULTS: Pre-PSM cure rates were comparable (suction-curettage: 89.6% vs. small-incision: 92.0%, p >0.05). Post-PSM analysis confirmed no significant difference (89.7% vs. 86.8%, p =0.791). Suction-curettage demonstrated significantly fewer complications: cutaneous necrosis (10.3% vs. 27.9%, p =0.015), long-term pigmentation (5.9% vs. 16.2%, p =0.045), infection (2.9% vs. 11.8%, p =0.049), and hematoma (1.5% vs. 10.3%, p =0.029). Recrudesce rates were similar (8.8% vs. 7.4%, p =0.753). Suction-curettage yielded superior scar outcomes (lower POSAS scores, p <0.05) and faster healing (8.03±1.30 vs. 11.57±1.75 days, p <0.05). Multivariable analysis revealed BMI≥28kg/m², age>31 years, fasting glucose>6.0mmol/L, and surgical area>17cm² as independent risk factors for complications in both groups. CONCLUSION: Suction-curettage achieved non-inferior cure rates to small-incision surgery but with fewer complications, reduced scarring, and quicker recovery. Elevated BMI, age, glucose levels, or surgical area increased complication risks. These findings support suction-curettage as a safer alternative for axillary bromhidrosis.