September 28, 2026 | Body, Plastic Surgery
A patient came to see me about her abdomen. She wanted a light etching result, nothing dramatic, and we spent the first part of the visit on that. Then she mentioned her underarms, and said something I have heard from a lot of women in that chair.
“I feel like I’m always flashing people.”
Almost nobody arrives knowing this has a name. Most have been told for years that it is stubborn fat. It usually is not. Rather than write around the consult, here are the answers straight from my dictation, identifiers removed.
“Can you do something about my stomach, but not a six pack?”
“So we can do the verticals. We can do it a little bit here. You don’t have a lot of fat, but we can plug it a little bit here, a little triangle here, and then go up and down. And then just remove a little here and use the J Plasma to tighten up the skin.”
On a lean patient, etching is a subtle vertical definition plus skin tightening, not a bodybuilder result.
“What is the fullness under my arm? Can you just liposuction it?”
“So I will have to make the little incision here on the axilla, that I can get that tissue out, because it’s more like gland, it’s not so much like fat. So if I try to get it out with liposuction, it really doesn’t go away. So the best way, I mean, if you don’t want a scar, I can try to get it out, and I actually have an arthroscopic shaver where I can get the gland out, and then we just cut out the nipple on each side.”
That distinction drives everything. Liposuction removes fat cells. Axillary breast tissue is glandular, so suctioning it leaves the fullness right where it was. It has to be removed as tissue, which is what the arthroscopic shaver is for. Many of these patients also have a small accessory nipple over the area, and it comes out through the same access.
“Will I have a visible scar?”
“The scar goes in the axilla, you don’t see it. One of the side effects is that I remove some of the sweat glands. It would actually be right on the crease, so it would look like a crease. And then I would still have to do just a little cut to remove the nipple itself. No, it wouldn’t be a thick scar, just the size of the nipple, so it just looks like a little line.”
The scar hides in a crease that already exists. The sweat gland reduction is a real side effect, and patients almost always count it as a bonus.
“How long does it take, and how long am I down?”
“This would take probably two hours, general anesthesia, in and out, you can go home the same day. Recovery I would say is like five days, but nothing more, you can go back to normal activity. And then exercise usually in about three weeks or so.”
“Can it be done awake?”
“This would have to definitely be under general anesthesia.”
“I have patients that have come and they’ve had it done and they’re like, oh, that was horrible. So this way we can be more aggressive, but we’re not worried about you being uncomfortable.”
Being able to work thoroughly in a sensitive area matters more here than avoiding anesthesia. Leaving gland behind is the one outcome nobody wants.
Why Choose Dr. Agullo?
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center. Cases like this get missed for years, usually because someone called it fat and moved on. Naming it correctly is most of the fix.
Ready to Talk?
Call my office at (915) 590-7900, text the consult line at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com.
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