Hyperhidrosis Surgery Program

About the Program

The Hyperhidrosis Surgery Program at Massachusetts General Hospital uses a minimally invasive surgical approach to managing upper-body hyperhidrosis (excessive sweating) for qualifying patients.

Our surgical team includes board-certified thoracic surgeons who have a long history of treating hyperhidrosis. Our surgeons perform the full range of thoracic surgery, bringing a level of skill and expertise to help ensure patient comfort and safety.

Since 1995, Mass General has offered a full range of care options to hyperhidrosis patients. Combining state-of-the-art technology with our tradition of surgical excellence, our minimally invasive treatment approach has proven to:

• Decrease incision size
• Reduce postoperative recovery time
• Quicken an individual’s return to full activity

At Mass General, patients undergo the procedure at a world-renowned hospital that provides safe, high-quality care in virtually every specialty and subspecialty of medicine and surgery.

About Hyperhidrosis

Hyperhidrosis occurs when the body creates perspiration in excess of what is necessary to cool itself. The process of sweating is controlled by the sympathetic nervous system. This involuntary nervous system controls millions of sweat glands throughout the body, including many glands located in the hands.

Our bodies naturally sweat to regulate body temperature. When this condition affects the hands (palmar hyperhidrosis) or armpits (axillary hyperhidrosis) it can have a dramatic impact on the patient's everyday life. In many cases, it can compromise his or her ability to function in the workplace and at home.

Our surgical approach, thoracoscopic or robotic sympathectomy, can eliminate hyperhidrosis of the hands and also can help decrease armpit perspiration. We do not offer surgical treatment for hyperhidrosis of the feet or total body.

Conditions We Treat

Palmar Hyperhidrosis: Hand Sweating

Excessive hand sweating, known as palmar hyperhidrosis, is the most common presentation of hyperhidrosis. Excessive hand sweating can be quite severe by affecting a patient's life both functionally and socially.

In most patients, the problem is genetic. Palmar hyperhidrosis usually begins in childhood and becomes more severe toward early adulthood.

Axillary Hyperhidrosis: Armpit Sweating

Some armpit sweating and odor is normal in all people past puberty. When excessive, it is termed axillary hyperhidrosis.

Topical deodorants and antiperspirants may be an appropriate treatment for some patients, and thoracoscopic sympathectomy may be an appropriate axillary hyperhidrosis treatment, which can offer benefits to some patients with this complaint. Botox injections or thermal ablation of the sweat glands are sometimes recommended as medical treatment for armpit sweating.

Patients with primary armpit sweating can be considered for surgery, but the failure rate can reach 15-20%.

Evaluation Process

As the patient, you and your loved ones are the center of the care team. It’s important that you know what to expect for evaluation of your condition. All patients undergo a comprehensive evaluation of their condition to determine the best approach to managing their upper-body hyperhidrosis.

As a first step, patients typically consult with their primary care physician or dermatologist, and are then referred for evaluation at Mass General. In the evaluation, your care team will go over with you the symptoms that you experience and the level of disruption that they cause in your daily life in areas such as exercise, school, work and socializing.

Depending on the outcome of this evaluation, your care team may discuss with you the option of medical therapies such as topical agents, towelettes, a trial of oral anticholinergic medicine, or iontophoresis. Medical treatment is typically tried as a first step in the treatment of hyperhidrosis. If you have tried medical therapies in the past and they have not been effective, your care team will discuss with you the option for surgery.

Because of the comprehensive evaluation at Mass General, the outcomes for patients who undergo surgery to treat their upper-body hyperhidrosis are excellent.

Surgical Treatment

For patients with severe upper-body hyperhidrosis who have failed nonsurgical treatments, we may recommend a procedure known as thoracoscopic sympathectomy. This minimally invasive procedure is performed through several small incisions in each armpit. Although surgery for hyperhidrosis is relatively simple, as with all operations, it still carries some risk. Your care team will review any questions or concerns you might have prior to surgery.

While the patient is under anesthesia, a small scope with a camera is inserted into the chest cavity. The surgeon can then identify and interrupt the nerve ganglia that are responsible for the excess sweating. This technique optimizes the patient’s result and reduces the occurrence of complications. Most patients treated with this technique can leave the hospital within hours and resume normal activities within one week.