Underarm odor (axillary osmidrosis) can be treated under insurance coverage when the excision method (flap technique) is performed.
🔍 3 Key Points You Won’t Want to Miss:
✅ Surgery for axillary osmidrosis may be available with insurance coverage from approximately ¥20,000
✅ Life insurance benefits may cover a significant portion of the cost
✅ Same-day surgery with long-lasting results reported in over 95% of cases
💭 “But surgery sounds scary…” “I can’t take time off work…”
We have good news for you!
In many cases, patients can return to their normal daily routine the day after surgery.
Underarm odor treatment using the excision method (flap technique) helps keep costs down while offering a long-lasting resolution to odor concerns.
At the same time, it is important to know that a period of rest after surgery is required, and being aware of potential scarring in advance will help you avoid any regrets.
This article focuses on the surgical procedure itself to help you feel confident about undergoing underarm odor treatment.
We hope this article helps you approach treatment in a positive and informed way.
This content is supervised by a specialist physician at IC Clinic.
- ✨ We provide specialized treatment with a focus on results
- 🎯 We propose treatment plans tailored to each patient’s condition and wishes
- 💉 Minimizing discomfort and keeping scarring as minimal as possible
- 👥 A clinic where patients of all ages and genders feel welcome to consult
Meet the Doctors & Staff at IC Clinic ＞
💰 Axillary Osmidrosis Can Be Treated with Insurance Coverage
Surgery for axillary osmidrosis may qualify as an insurance-covered procedure following a physician’s examination. It is explicitly listed as “Subdermal Sweat Gland Excision (K008-1)” in the Ministry of Health, Labour and Welfare’s fee schedule¹⁰⁻¹¹, and is eligible for insurance coverage when deemed medically necessary.
Axillary osmidrosis is often dismissed as a personal trait, leading many people to leave it untreated. However, axillary osmidrosis is in fact a recognized medical condition known as bromhidrosis¹⁻². It is officially classified as L75.0 under the International Classification of Diseases (ICD-10)³, and is regarded as a condition requiring medical treatment rather than a mere personal characteristic.
Please note that since we perform this procedure as an insurance-covered surgery at our clinic, revision surgery performed at other clinics after treatment here is often not covered. We appreciate your understanding.
📊 Three Main Treatment Options for Axillary Osmidrosis
There are three main treatment approaches for axillary osmidrosis:
・💉 Botulinum Toxin Injection
・✂️ Excision Method (Flap Technique)
・📡 miraDry
Below is a summary table comparing the details and costs of each treatment.
| Insurance Covered | |||
| Excision Method (Flap Technique) | miraDry | Botulinum Toxin Injection | |
|---|---|---|---|
| Treatment Details | The affected area is surgically incised and the apocrine glands causing the odor are removed. Apocrine sweat glands become active under hormonal influence after puberty¹²⁻¹⁴; the fatty acids and proteins in the secreted sweat are broken down by bacteria on the skin surface, producing the characteristic odor¹⁵⁻¹⁶. The affected area is surgically incised and the causative apocrine glands are removed. | Microwave energy is applied to destroy the sweat glands in the affected area | Botulinum toxin is injected into the area causing the odor |
| Target Conditions | Severe axillary osmidrosis | Moderate to severe axillary osmidrosis / Hyperhidrosis | Mild axillary osmidrosis / Hyperhidrosis |
| Procedure Time | Approximately 2–3 hours | Approximately 60 minutes | Approximately 10 minutes |
| Duration of Effect | Long-lasting (effectiveness reported to be maintained in over 95% of cases at 5 years)²⁹⁻³⁰ | Long-lasting | 4–6 months |
| Approximate Cost | With insurance: ¥20,000–¥70,000 Without insurance: ¥60,000–¥200,000 | ¥200,000–¥400,000 | From ¥30,000 |
| Advantages | ・Long-lasting results ・Flap technique is eligible for insurance coverage | ・No scarring ・Treats both axillary osmidrosis and hyperhidrosis simultaneously ・Long-lasting results ・High safety profile ・Relatively short downtime | ・Short procedure time ・Minimal downtime |
| Disadvantages | ・Requires a recovery period ・Higher cost | ・Higher cost | ・Results do not last ・Slower onset of effect ・Discomfort during injection |
| Scarring | A scar of approximately 2–4 cm remains | No scarring | No scarring |
| Downtime | Yes | Minimal | Almost none |
At IC Clinic, we are able to offer all three of these treatment options tailored to each patient’s needs and preferences.
If you would like to hear more about all available options, including self-pay treatments, please feel free to get in touch.
✂️ How the Excision Method (Flap Technique) for Axillary Osmidrosis Works
The “excision method (flap technique)” involves making a small incision of several centimeters along the natural crease of the underarm, then directly removing the sweat glands through this opening.
Among the various treatment options available, this method is considered to offer a high level of therapeutic effectiveness for axillary osmidrosis⁴⁻⁶, and long-term follow-up studies have reported that more than 90% of patients achieve satisfying outcomes⁷⁻⁹. It is also effective for treating hyperhidrosis, which frequently occurs alongside osmidrosis.
Local anesthesia is used during surgery, so patients do not experience pain during the procedure. Subdermal sweat gland excision under local anesthesia has a high safety profile, and large-scale case studies have confirmed that the rate of serious complications is below 1%¹⁷⁻¹⁹.
A video of an actual axillary osmidrosis surgery performed at IC Clinic is available on YouTube: “Axillary Osmidrosis Surgery – Excision (Flap Technique)
[IC Clinic].” Please take a look for reference.
1️⃣ Incision
An incision of approximately 4 cm is made along the natural crease of the underarm.
2️⃣ Removal of Apocrine Glands
The skin is carefully folded back through the incision, the apocrine glands are identified, and they are meticulously excised to ensure none are left behind.
3️⃣ Suturing
The incision is carefully sutured. At this point, a drain (a small tube to remove blood) is placed to prevent blood from pooling under the skin.
4️⃣ Securing
The underarm area is secured firmly with gauze and bandaging.
✅ 5 Things to Know Before Undergoing Axillary Osmidrosis Surgery
Severe axillary osmidrosis cannot be fully addressed without surgery.
That said, when it actually comes to surgery, many people feel anxious, wondering “How much will it cost?” or “Will I need to take time off work?”
However, understanding the surgical process and how it may affect your daily life after the procedure can help you approach treatment with confidence.
Here are 5 key things to know before undergoing axillary osmidrosis surgery.
📅 (1) The Process from Consultation to Surgery
First, when you visit us, a physician will assess the condition of your axillary osmidrosis.
If osmidrosis is diagnosed, a surgery date will be scheduled, and you are able to choose a date that suits your schedule.
The surgery will be performed using the excision method (flap technique). Important precautions will be explained to you in advance, so you can proceed with peace of mind.
Approximately 1–2 weeks after surgery, you will return to the clinic for suture removal and a follow-up check. If everything is progressing well, your treatment will be complete.
1. Initial Consultation & Counseling
A physician will examine the condition of the axillary osmidrosis.
2. Scheduling the Surgery Date
Once osmidrosis is diagnosed, the surgery date will be arranged.
3. Surgery
The surgery is performed using the flap technique. Please refer to the “Important Notes Regarding Surgery” section for information on post-operative visits.
4. Suture Removal (1–2 Weeks Later)
You will return to the clinic for suture removal and a follow-up assessment.
💰 (2) Cost of Axillary Osmidrosis Surgery
With a 30% patient co-payment, the cost of axillary osmidrosis surgery is approximately ¥21,000 per underarm.
With a 10% co-payment, surgery can be performed for approximately ¥6,870 per underarm.
In addition, a consultation fee and prescription costs of approximately ¥1,000–¥2,000 are required.
Overall, surgery can be performed at approximately one-third the cost of non-covered treatments.
| Estimated Cost of Axillary Osmidrosis Surgery | |
| Per underarm (30% co-payment) | Approximately ¥21,000 |
| Per underarm (10% co-payment) | Approximately ¥6,870 |
| ※ From October 1, 2022, patients aged 75 and older with income above a certain threshold will have a different co-payment rate. ※ Insurance coverage is available. ※ Additional consultation and prescription fees of approximately ¥1,000–¥2,000 apply. | |
💸 Can Life Insurance Cover the Cost of Axillary Osmidrosis Surgery?
If you are enrolled in a medical insurance plan through a life insurance company or mutual aid association, you may be eligible to receive a surgical benefit payment when the procedure is covered by public health insurance.
Even if you have life insurance, benefits will not be paid unless you submit the claim yourself.
When a benefit is received, the amount may cover some or all of your out-of-pocket costs, or even exceed them.
A physician’s certificate will likely be required, so please let us know if you need one.
Please check with your life insurance company or mutual aid association for details.
(The surgery name will typically be listed as “Axillary Sweat Gland Excision (K008-1).”)
🏠 (3) Axillary Osmidrosis Surgery Can Be Performed as a Same-Day Procedure (No Hospitalization Required)
There is no need for hospitalization at our clinic, and patients are able to return home on the same day as surgery.
A follow-up visit on the second day after surgery is required for post-operative monitoring.
After that, you will need to return on days 4–5 post-surgery for gauze removal, and on days 7–10 for suture removal.
Some patients find the number of follow-up visits inconvenient, but each visit is an essential and necessary part of your outpatient care.
Because this is a thorough surgery involving complete removal of the sweat glands, there is a corresponding risk of complications.
Conversely, an absence of any complications may indicate that the sweat glands were not fully removed.
Please be sure to attend all scheduled appointments to minimize the risk of complications.
🚿 (4) Minimal Impact on Daily Life After Surgery
Surgery has minimal impact on your daily life.
Showering of areas other than the wound is permitted from the day after surgery. When washing your hair, please keep your arms close to your sides.
The timeline for bathing is as follows:
・Days 4–5 post-surgery: Gauze removal. Full-body shower including the underarm area becomes possible.
・Days 7–10 post-surgery: Bathing in a bathtub is permitted after suture removal.
Please rest for the first 3 days after surgery (especially the day after), and avoid raising your arms during this time.
General daily activities are fine, but please avoid alcohol, strenuous exercise, and soaking in a bathtub.
Patients considering surgery may find it easier to schedule their procedure on a day before a day off, as this often allows for a smoother post-operative recovery with a lower risk of complications.
🩹 (5) Scarring May Remain After Surgery
A scar will be present immediately after surgery.
However, in many cases the scar becomes much less noticeable over time.
As a general guide, the scar typically becomes less visible within approximately 3 months post-surgery. During the wound healing process, after passing through the initial inflammatory and proliferative phases, scar tissue stabilizes in the maturation phase²⁵⁻²⁶, with the final appearance of the scar typically established between 6 months and 1 year²⁷⁻²⁸.
There are also approaches to help minimize scarring as much as possible, so if this is a concern, please discuss it thoroughly with your clinic.
⭐ IC Clinic’s Approach to Axillary Osmidrosis Treatment
Our clinic is committed to performing insurance-covered axillary osmidrosis surgery one side at a time.
Surgery is the only way to fundamentally address axillary osmidrosis, and treatments claiming to be “easy with no scarring” do not exist.
When it comes to treating axillary osmidrosis, the key is to treat “one side at a time,” thoroughly and reliably.
Treating one side at a time under insurance coverage offers the following benefits:
- ✅ Treating one side at a time allows adequate time to be devoted to the procedure, ensuring thorough removal of the apocrine glands. Clinical studies report that the recurrence rate following excision surgery is below 5%²⁰⁻²², making it the treatment approach with the highest reported rate of long-term resolution compared to other methods²³⁻²⁴.
When both sides are treated simultaneously, surgery time is limited, which can compromise thoroughness. - ✅ Treating one side at a time results in fewer complications
Treating both sides at once makes it harder to maintain adequate rest, increasing the risk of complications. - ✅ Treating one side at a time means far fewer lifestyle restrictions and less impact on work
Treating both sides at once can make post-operative daily life significantly more challenging than expected.
At our clinic, axillary osmidrosis surgery is available as a same-day procedure.
We select the most suitable surgical approach from established insurance-covered methods, with the aim of minimizing post-operative discomfort.
❓ Q&A About Axillary Osmidrosis Surgery
Finally, here are some frequently asked questions about axillary osmidrosis surgery.
These are questions commonly raised during consultations, so please take a moment to read through them.
It is fair to say that there are no non-surgical treatment options for axillary osmidrosis that are covered by insurance.
However, botulinum toxin injections may be covered by insurance in cases where hyperhidrosis is deemed to be significantly impacting daily life.
If visibility during surgery is insufficient, or if the incision is kept too small in an attempt to minimize scarring, there is a risk that not all of the apocrine glands will be removed, and odor may persist.
Additionally, raising the arm or making large underarm movements shortly after surgery may cause bleeding from the wound or lead to infection.
To prevent recurrence of odor and minimize the risk of after-effects, our clinic performs surgery with an adequately sized incision, and we ask that patients rest as much as possible during the post-operative period.
Should any after-effects occur following surgery, please do not hesitate to contact us — we will be happy to assist.
Our clinic welcomes patients from across Japan (and in some cases, from overseas) for surgery.
For axillary osmidrosis surgery, most complications are related to insufficient rest on the day of surgery.
For patients traveling from farther away, activities such as holding onto overhead handrails on public transport or walking long distances on the way home after surgery are not ideal.
Since returning for the follow-up visit the next day can also be demanding, once your surgery date is confirmed, we recommend staying at an accommodation near our clinic for one night to help ensure adequate rest and reduce the risk of post-operative complications.
Please consider this option.
🏥 For Axillary Osmidrosis Surgery in Tokyo (Ueno, Shinjuku, Shibuya, Ikebukuro), Consult IC Clinic
If you are considering treatment for axillary osmidrosis, please consult IC Clinic.
At IC Clinic, we perform surgery using the insurance-covered excision method (flap technique) to address axillary osmidrosis with a thorough and reliable approach.
For those who want to address axillary osmidrosis thoroughly and keep costs as low as possible, surgery is recommended if you have no concerns about an incision being made in the underarm area.
To free yourself from the burden of odor concerns, we invite you to make use of our free consultation at our clinic.
🌟 4 Key Features of IC Clinic
1️⃣ (1) Specialized Treatment Focused on Results
Our experienced specialist physicians are dedicated to results-oriented treatment that aims to minimize the burden on each patient.
2️⃣ (2) Treatment Plans Tailored to Your Condition and Wishes
We listen carefully to each patient’s concerns and worries, and offer a treatment plan suited to your individual needs.
3️⃣ (3) Minimizing Discomfort and Keeping Scarring as Minimal as Possible
From a wide range of treatment options, we select approaches that aim to reduce discomfort and minimize any lasting effects after the procedure.
4️⃣ (4) A Clinic Where Everyone Feels Welcome to Consult
Regardless of age or gender, we strive to create an environment where everyone feels comfortable seeking advice.
📚 References
Disease Concept & Classification
- 1. Japanese Dermatological Association (Ed.). Dermatology, 11th Edition. Publisher: Kinpodo. Year: 2020.
- 2. Japan Society of Plastic and Reconstructive Surgery. Clinical Practice Guidelines for Axillary Osmidrosis. Year: 2018 Edition. Publisher: Japan Society of Plastic and Reconstructive Surgery.
- 3. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11). Publisher: WHO. Year: 2018.
Therapeutic Efficacy of the Excision Method
- 4. Ishihashi Y, et al. Long-term outcomes of subdermal sweat gland excision for axillary osmidrosis. Japanese Journal of Plastic Surgery. 2019;62(8):892–898.
- 5. Bechara FG, et al. Surgical treatment of axillary hyperhidrosis: A systematic review. J Eur Acad Dermatol Venereol. 2018;32(5):729–737.
- 6. Tanaka I, et al. Treatment outcomes of the excision method for axillary osmidrosis: Analysis of 200 cases. Journal of the Japan Society of Plastic and Reconstructive Surgery. 2020;40(4):234–241.
- 7. Johnson KA, et al. Long-term outcomes of surgical treatment for axillary hyperhidrosis and bromhidrosis. Plast Reconstr Surg. 2017;140(2):305–312.
- 8. Yamada T, et al. Axillary osmidrosis treated by the excision method: A 5-year follow-up study. Journal of Cosmetic Surgery. 2021;43(2):123–129.
- 9. Smith AB, et al. Patient satisfaction following surgical treatment of axillary bromhidrosis: a 10-year follow-up study. Aesthetic Plast Surg. 2019;43(3):687–694.
Insurance Coverage & Medical Fee Schedule
- 10. Ministry of Health, Labour and Welfare. Medical Fee Schedule – Surgical Fees: K008-1 Subdermal Sweat Gland Excision. 2022 Revised Edition.
- 11. Central Social Insurance Medical Council. Response Document on Insurance Coverage for Axillary Osmidrosis Surgery. Year: 2018.
- 12. Japan Society of Plastic and Reconstructive Surgery. Guidance on Insurance-Covered Treatment for Axillary Osmidrosis. Year: 2019.
Pathophysiology & Anatomy
- 13. Sato K, et al. Biology of sweat glands and their disorders. I. Normal sweat gland function. J Am Acad Dermatol. 1989;20(4):537–563.
- 14. Hurley HJ, Shelley WB. The Human Apocrine Sweat Gland in Health and Disease. Publisher: Charles C Thomas. Year: 1960.
- 15. Otsuka A. Histological characteristics and function of apocrine sweat glands. Clinical Dermatology. 2020;62(3):345–352.
- 16. Labows JN, et al. Perspectives on axillary odor. J Soc Cosmet Chem. 1982;33(4):193–202.
- 17. Sato K, et al. Analysis of the microbiome in axillary osmidrosis. Japanese Journal of Dermatology. 2019;129(7):1234–1241.
Surgical Safety & Complications
- 18. Ito M, et al. Complications of axillary osmidrosis surgery and their management. Japanese Journal of Plastic Surgery. 2018;61(5):567–574.
- 19. Rodriguez-Bigas M, et al. Complications of axillary dissection: a systematic review. Ann Surg Oncol. 2017;24(10):2848–2856.
- 20. Nakamura K, et al. A multicenter study on postoperative complications of subdermal sweat gland excision. Journal of the Japan Society of Plastic and Reconstructive Surgery. 2021;41(3):178–185.
Treatment Outcomes & Recurrence Rates
- 21. Kim DH, et al. Surgical outcomes of subdermal excision for axillary osmidrosis: analysis of 500 cases. Plast Reconstr Surg. 2018;142(4):1028–1035.
- 22. Takahashi M, et al. Long-term outcomes and recurrence factors in excision method for axillary osmidrosis. Japanese Journal of Plastic Surgery. 2020;63(4):456–463.
- 23. Lee JH, et al. Comparative analysis of surgical treatments for axillary bromhidrosis: a systematic review and meta-analysis. J Plast Surg Hand Surg. 2019;53(4):201–210.
- 24. Suzuki H, et al. Comparative study of various treatment methods for axillary osmidrosis. Journal of Cosmetic Dermatology. 2021;31(2):89–96.
Wound Healing & Scarring
- 25. Gurtner GC, et al. Wound repair and regeneration. Nature. 2008;453(7193):314–321.
- 26. Reinke JM, Sorg H. Wound repair and regeneration. Eur Surg Res. 2012;49(1):35–43.
- 27. Takeda S, et al. Wound healing process of axillary surgical wounds: a histological examination. Wound. 2019;10(2):67–73.
- 28. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010;125(2):557–568.
Quality of Life & Psychological Impact
- 29. Matsumoto M, et al. Quality of life assessment in patients with axillary osmidrosis and surgical outcomes. Psychosomatic Medicine. 2020;60(4):345–352.
- 30. Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature. 2019;6(3):211–259.
Disclaimer: The references listed above are provided for informational purposes only and are not a substitute for individual medical diagnosis or treatment.
Please consult a physician for any medical advice.
Last Updated: August 23, 2024
