Reconstructive surgery · New York and New Jersey
Hidradenitis Suppurativa Surgery
Surgery for hidradenitis suppurativa (HS) in the armpits, groin, buttocks, under the breasts, and anywhere else it appears: removal of the lumps, tunnels, and scarring that keep coming back, and reconstruction of the wound that is left. Dr. Steven Ovadia is a board certified plastic and reconstructive surgeon with offices in New York City and New Jersey.
Overview
What hidradenitis suppurativa is
Hidradenitis suppurativa is a long-term inflammatory skin condition. It starts in the hair follicles of the skin folds and causes painful lumps and abscesses that drain and come back, often in the same places. Over time, tunnels form under the skin and the area scars.
It is not caused by poor hygiene and it is not contagious. It often starts after puberty, and it can affect anyone.
Medical treatment, usually led by a dermatologist, can calm the inflammation. It includes antibiotics and, for many patients, biologic medications such as adalimumab (Humira), secukinumab (Cosentyx), or bimekizumab (Bimzelx). Tunnels and scar tissue, though, rarely go away with medicine alone. Surgery removes the affected skin and tissue in an area, and is often part of treatment alongside medical care.
Signs and stages
How hidradenitis progresses
Hidradenitis ranges from a few lumps that come and go to tunnels and scarring across a whole area.
Painful lumps
Deep, tender lumps in the skin folds that look like boils. They can go away and come back in the same place.
Abscesses and drainage
Lumps that swell, open, and drain pus or fluid, often with an odor, staining clothing and dressings.
Tunnels under the skin
Over time, channels called tunnels or sinus tracts form under the skin and connect the lumps. They keep draining and rarely heal on their own.
Scarring
Repeated flares leave thick, rope-like scars that can tighten the skin and limit how far the arm or leg moves.
Stages (Hurley staging)
| Stage I | Stage II | Stage III | |
|---|---|---|---|
| What it looks like | Single or a few separate lumps or abscesses, no tunnels or scarring | Lumps and abscesses that come back, with some tunnels and scarring, separated by normal skin | Tunnels and scarring connected across the whole area |
| Usual treatment | Skin care and medical treatment | Medical treatment; surgery for areas that keep coming back | Medical treatment and surgery to remove the affected area |
A red, hot, swollen area with fever, or redness that is spreading, should be seen right away.
Areas treated
Hidradenitis surgery by area
Where the disease is decides how much skin is removed, how the wound is closed, and what recovery involves.
Armpits
One of the most common areas. Scarring here can tighten the skin and limit raising the arm. When the affected skin is removed, the wound is closed or covered so that the arm keeps its movement as it heals.
Groin and inner thighs
Disease in the groin, the creases of the inner thigh, and the pubic area. The skin here moves and stretches with walking and sitting, which is part of how the closure is planned.
Buttocks and under the breasts
Disease in the buttocks, the crease between them, and under the breasts. These areas can cover a large surface, and treatment may be done in stages.
Dr. Ovadia treats hidradenitis wherever it appears, including the back, the neck, the abdomen, and the genital area. Many patients have it in more than one area; he plans which comes first, usually starting with the one causing the most trouble.
Surgery
What hidradenitis surgery involves
Surgery removes the affected skin, the tunnels, and the scar tissue in an area, down to healthy tissue. Removing the whole affected area, rather than only draining or opening individual lumps, gives the lowest chance of the disease coming back in that spot.
The goal is to remove the tissue that keeps flaring, so that area stops draining and hurting. Surgery may be done in one operation or in stages, depending on the areas and how much is affected.
Consultation
Dr. Ovadia examines the affected areas, asks about your flares and treatment so far, and explains which areas surgery can help and what each would involve.
Planning
The plan sets which areas come first, how much is removed, how the wound will be closed, and whether it is done in one operation or in stages.
Surgery
The affected skin, tunnels, and scar tissue are removed down to healthy tissue, and the wound is closed or dressed. When planning your operation, Dr. Ovadia goes over where it is done, the anesthesia, and whether you go home the same day.
Healing and follow-up
The wound is checked regularly while it heals. Follow-up visits watch for new areas so they can be treated early.
Every surgery has risks. For hidradenitis surgery these include bleeding, infection, wounds that are slow to heal, a skin graft or flap that does not fully take, fluid collecting under the skin, tightness or limited movement as the scar heals, hidradenitis coming back at the edges or in another area, and the need for further surgery. Smoking and vaping raise the risk of healing problems. Dr. Ovadia goes over them with you at your consultation.
Closing the wound
How the wound is closed
How the wound is reconstructed depends on its size, where it is, and what is found at surgery. A small wound can sometimes be closed directly with stitches; larger wounds need another approach. Dr. Ovadia goes over the likely options with you before surgery, and the final choice is made for the wound in front of him.
Healing on its own
The wound is left open and heals from the base and edges with regular dressing changes. It takes weeks to months, depending on the size.
Wound vacuum
A sealed foam dressing attached to gentle suction can speed healing of a larger wound and prepare it for a skin graft.
Skin graft
A thin layer of skin is taken from another part of your body, such as the thigh, and placed over the wound.
Local flap
Nearby skin and tissue, with its own blood supply, is moved over the wound to close it, so that the area heals with skin that moves and stretches.
Recovery
What to expect after hidradenitis surgery
Depends on the area and the closure
A small excision closed directly heals faster than a large wound left to heal on its own. Dr. Ovadia tells you what to expect for your surgery.
Wound care
If the wound is left open or a skin graft is placed, you are shown how to care for it, and dressings are changed on a schedule. A visiting nurse may help at home.
Drains may be placed
A drain may be placed under the skin to remove fluid, depending on the area and how it is closed. If you have drains, you are shown how to care for them, and they are removed in the office.
Movement
After surgery in the armpit or groin, movement is limited at first to protect the closure, then brought back gradually so the area does not tighten as it heals.
Ongoing medical treatment
Surgery treats the areas that are removed. Medical treatment for hidradenitis usually continues afterward, managed with your dermatologist.
Follow-up
Hidradenitis can appear in new areas or at the edges of a treated area. Follow-up visits watch for this so it can be treated early.
Spreading redness, increasing pain, new drainage or bleeding from the wound, or a fever should be brought to your physician's attention right away.
A general timeline
This is a general guide. Recovery depends on the area, the size of the wound, and how it is closed, and everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Insurance
Cost and insurance
Surgery for hidradenitis suppurativa may be covered by insurance when the plan's medical criteria are met and it is a covered benefit of your policy. Once Dr. Ovadia has examined you and surgery makes sense, the office evaluates the criteria and covered benefits available under your plan, prepares the prior authorization, and works through the request with you.
The cost depends on the areas treated, how the wounds are closed, and whether more than one stage is planned. We go over it with you once your surgical plan is set.
What insurers usually look for
- A diagnosis of hidradenitis suppurativa
- Lumps, abscesses, or tunnels that keep coming back in the same area
- Drainage, pain, or scarring that limits movement or daily life
- Medical treatment that has been tried
- Medical records and photographs that document the problem
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
His reconstructive practice includes wound care, skin grafts, and flap reconstruction, which he draws on in planning hidradenitis surgery. See also scar revision. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about hidradenitis surgery
What is hidradenitis suppurativa?
Hidradenitis suppurativa, or HS, is a long-term inflammatory skin condition that starts in the hair follicles of the skin folds, such as the armpits, groin, buttocks, and under the breasts. It causes painful lumps and abscesses that come back, and over time tunnels and scarring under the skin.
When is surgery a good option for hidradenitis?
Surgery is considered when lumps, abscesses, or tunnels keep coming back in the same area despite medical treatment, or when tunnels and scarring have formed. Medicine can calm inflammation, but tunnels and scar tissue usually do not go away without surgery.
Will hidradenitis come back after surgery?
It can. Removing the whole affected area gives the lowest chance of it coming back in that spot, but hidradenitis can appear at the edges of a treated area or in a new area. Continuing medical treatment with your dermatologist helps lower that risk.
Why not just drain the abscess?
Draining an abscess relieves pain quickly, but it leaves the tunnels and inflamed tissue behind, so the abscess usually comes back. Removing the affected tissue treats the source in that area.
How is the wound closed after surgery?
It depends on the wound: its size, where it is, and what is found at surgery. A wound may be closed directly, left to heal on its own with dressing changes, helped along with a wound vacuum, covered with a skin graft, or closed with a flap of nearby tissue. Dr. Ovadia goes over the likely options with you before surgery.
Do I need to stop my medications before surgery?
Some medications for hidradenitis may be paused around surgery, and others continued. Do not stop any medication on your own. Dr. Ovadia coordinates the timing with you and the doctor who prescribes it.
Is hidradenitis surgery covered by insurance?
It can be. Some insurance plans cover surgery for hidradenitis suppurativa when their medical criteria are met and it is a covered benefit of your policy. Each plan sets its own criteria. If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey. Clear photographs of the affected areas help a great deal.
Next step
Start with a consultation
Dr. Ovadia will examine the affected areas, review the treatment you have had, and explain which areas surgery can help, how each wound would be closed, and what recovery involves.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com