Infraareolar access for thoracoscopic sympathectomy to treat primary hyperhidrosis

We herein present a new technique for performing thoracoscopic sympathectomy to treat primary hyperhidrosis in both genders and all ages through the mammary infraareolar access associated with the axillary access. We believe that these points of access are feasible and safe, and result in an excellent cosmetic outcome without compromising the efficacy of the thoracoscopic sympathectomy. The existence of adhesions between the parietal and visceral pleura, the presence of large breasts, and lactation made it difficult to perform the surgery, but did not make it impossible to apply the technique using the infraareolar access. However, the presence of breast implants is a contraindication for the new access.