What is a sternotomy?
A sternotomy is a surgical procedure that makes an incision through the breastbone, or sternum, in the middle of the chest and spreads the two sides apart. This process allows your surgeon to access the heart and lungs as well as other tissues or organs in your chest that require surgery.
A thoracic surgeon or a cardiothoracic surgeon typically performs a sternotomy. It’s a standard surgical approach used when someone needs major surgery in the chest area, like for open heart surgery or transplant.
Types of sternotomy
Median sternotomy
A median sternotomy is the most common type of incision used in cardiothoracic surgery. This type of sternotomy uses an incision vertically down the middle of the chest and through the breastbone. Your care team may recommend a median sternotomy for heart or lung conditions that can’t be treated with less invasive options.
One of the most common reasons to have a median sternotomy is open heart surgery. During this procedure, your surgeon can fix congenital heart conditions or perform coronary artery bypass grafting, known as CABG, to restore blood flow in the heart. This type of sternotomy is also used for heart transplants and heart valve surgery.
Mini sternotomy
A mini sternotomy is a type of sternotomy with a smaller incision than a median sternotomy. Instead of a long incision down the entire breastbone, a mini sternotomy incision is only a few inches. It’s commonly used for surgery to replace the aortic valve in the heart.
Clamshell sternotomy
A “clamshell” sternotomy is also called a traverse sternotomy or anterolateral thoracotomy. This surgical procedure uses an incision horizontally across the chest. It’s often used for major trauma in the chest area and for lung transplant.
Why is a sternotomy performed?
A sternotomy is performed to treat serious or major medical conditions in the chest area. This type of surgery could include surgery on organs like the heart, lungs or esophagus or treatment for conditions affecting the body’s largest blood vessel—the aorta.
Some reasons you might need a sternotomy include:
- Coronary artery bypass surgery
- Heart transplant
- Congenital heart disease
- Heart valve conditions
- Lung transplant
- Lung cancer
- Mediastinal tumors
- Esophageal reconstruction
- Thymus cancer
- Aortic aneurysm
- Spine or bone conditions
Thoracotomy vs sternotomy
Thoracotomy and sternotomy are two common surgical approaches used in treating conditions in the chest. However, the types of incisions vary, and the goals are different.
The primary type of thoracotomy—called posterolateral thoracotomy—uses an incision between the ribs from the side of your chest around to your back. It is used for lung cancer treatment when minimally invasive options are not possible.
The primary type of sternotomy—called median sternotomy—uses an incision down the middle of the chest along the breastbone and is more common for cardiac surgery.
Preparing for a sternotomy
To prepare for a sternotomy, your doctor will review your health history, medications and lifestyle and give instructions on any changes you need to make to your routine before your procedure.
You’ll also have additional testing, such as blood tests or imaging tests, to make sure you are healthy enough to have a sternotomy. Because sternotomy is a major surgery, you should choose a caregiver and take steps to support a smooth recovery at home.
Be sure to follow your doctor’s specific orders to get ready for surgery, including:
- Stopping medications, such as blood thinners
- Stopping herbal medications or supplements
- Quitting smoking or stopping alcohol
- Completing pre-admission testing
- Making healthy diet and exercise choices
- Preparing your skin with an antiseptic cleanser
- Stopping food and liquids before your surgery
The sternotomy procedure
Before surgery
You’ll check in and change into a hospital gown when you arrive for your surgery. Be sure to leave any valuables with your loved ones. Before surgery, you’ll talk with a few care providers, such as your nurse, surgeon and anesthesiologist. Your care team will place monitors on you and start an IV drip. You may also have compression sleeves on your legs to help prevent blood clots.
During surgery
Once you are asleep in the operating room, a breathing tube will be placed through your mouth, and you’ll have a urinary catheter placed to help collect urine. Your surgeon will then make your sternotomy incision, including cutting through the breastbone and perform your specific surgical procedure.
At the end of your surgery, your surgeon will place a chest tube to help drain air and fluid from the surgery site. Your surgeon will use wires or a special glue to connect your breastbone back together. Then, your incision is closed up, and you’ll go to the recovery room—called the Post-Anesthesia Care Unit or the Intensive Care Unit, depending on the procedure performed.
What are sternotomy wires?
Sternotomy wires are used to connect the two halves of the breastbone back together at the end of a sternotomy. These stainless-steel or titanium wires are usually left inside the body permanently. Your wires may be removed if you need another surgery, get an infection or have ongoing pain. Sternotomy wires are sometimes replaced with titanium or steel plates or a combination of wires and plates.
After surgery
From the hospital to care at home, your care team will guide you through each step of your recovery journey.
In the hospital
When you first wake up in the hospital, it’s normal to have several tubes and monitors connected to your body, which will be removed as you recover. During your hospital stay, your team will focus on helping you manage pain, getting you up and moving, and showing you how to prevent infection and blood clots. When you are walking, eating and breathing on your own, you’ll be ready to go home.
At home
At home, it’s important to always have a support person with you for the first week after surgery. Your doctor will give you a list of activities to avoid and a list of things to do. Follow these instructions and give yourself the time you need to recover—physically, emotionally and mentally.
Physically
To allow your body time to heal and for your safety, avoid activities like lifting, strenuous chores or exercise, and driving. Your care team will give tips to help you manage pain and feel more comfortable, such as sleeping on your side or back and using a pillow or sternal support vest.
Mentally
The first days at home after a sternotomy can feel overwhelming. However, having realistic expectations about your recovery ahead of time will help keep you in the right mindset. Your care team can help you understand what to expect and set small goals to help you on your path to healing.
Emotionally
It’s common to experience a range of emotions after a major surgery like a sternotomy. When you feel well enough, connect with friends and family and slowly get back to activities you enjoy, such as going out to eat, watching a movie or any other social activities. If you or a loved one notices significant changes in your mood, talk with your care team.
Risks and complications
Before your sternotomy, your doctor will talk with you about the procedure's goals, benefits and risks. As a major operation, sternotomy comes with some risks and potential complications. You may have risks related to the anesthesia and the surgical procedure itself. Understanding these risks and knowing what could signal a need for additional care is important.
Frequently asked questions
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Are sternotomy wires MRI safe?
Yes. There are no restrictions on getting an MRI if you have sternotomy wires. Sternotomy wires are made from titanium or stainless steel, and these aren’t affected by the magnets used by an MRI machine.
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How long does sternotomy pain last?
You may have pain for several weeks after a sternotomy. It’s common to have pain around the incision site in your chest. Any discomfort that lasts more than two months after surgery is considered post-sternotomy pain syndrome.
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How long does it take to recover from a sternotomy?
Expect anywhere from four to eight weeks to recover after your sternotomy. During this time, it’s important to follow your doctor’s orders and avoid any activities that could slow down your body’s ability to heal.
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How long is a sternotomy incision?
A full sternotomy incision is about eight to 10 inches long. An incision for a mini sternotomy is shorter—about three to four inches.
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Does a lung transplant require a sternotomy?
The traditional approach to lung transplant requires a clamshell sternotomy. However, new minimally invasive techniques for lung transplants are being developed.