Hidradenitis suppurativa (HS) is a chronic inflammatory disorder caused by follicular occlusion and rupture, leading to recurrent abscesses and dermal destruction. Severe cases, classified as Hurley Stage III, often require surgical intervention. This report presents a 27-year-old male with bilateral axillary Stage III HS persisting for 2 years. Despite a 10-week Adalimumab regimen, recurrent lesions necessitated surgical excision with bilateral thoracodorsal artery perforator (TDAP) V-Y advancement flaps. The patient exhibited successful wound healing and cicatrization and preserved functionality postoperatively. TDAP flaps present several advantages over skin grafts, including reliable vascularity, minimal donor site morbidity, and improved aesthetic results. This case demonstrates the effectiveness of TDAP V-Y advancement flaps in reconstructing axillary defects, significantly reducing the risk of recurrence. The patient's positive recovery and absence of procedure-related complications show that TDAP V-Y advancement flaps offer a superior, functional, and aesthetically pleasing option for managing severe HS.