Sternotomy

What is a sternotomy?

Sternotomy, also known as a median sternotomy, is a procedure to separate your sternum (breastbone). Cardiac surgeons frequently use it to access your heart and aortic arch during surgery.

Your sternum, or breastbone, is a flat, narrow bone that runs vertically (up and down) between your left and right rib cages. All of these bones are there to protect your heart and lungs, which are necessary for living. But when you have a heart problem that needs to be fixed, splitting and spreading your breastbone apart is often the best way for your surgeon to get to the area they need to reach.

An alternative to sternotomy, a mini sternotomy or upper hemisternotomy, is the most common way to reach your heart without doing a full sternotomy. A mini sternotomy uses an incision that’s only 2 to 3 inches long, which is about half the length of a traditional sternotomy. The incision starts between your breastbones and only goes down to about your fourth rib.

Is a sternotomy open heart surgery?

A median sternotomy procedure allows a surgeon the access they need to do open heart surgery. When they split your breastbone down the middle and open it, they can see and work on your heart.

Is a sternotomy major surgery?

Since it takes about two months for a sternotomy to heal, you can consider it major surgery. If you’re having a sternotomy, you’re most likely having open heart surgery, which is also major surgery.

Why would someone have a sternotomy?

A sternotomy allows a surgeon to get to areas your sternum and ribs protect, such as your:

• Heart.
• Aorta.
• Pulmonary arteries.

What does a sternotomy treat?

Some surgeries fix or remove a body part, but a sternotomy doesn’t do that. It’s an operation that allows your healthcare provider to temporarily move a bone out of the way so they can work on something under it. Most of the time, your provider needs to reach your heart through a sternotomy.

How common is a sternotomy?

A sternotomy procedure is very common. It’s the approach cardiac surgeons use most often for coronary artery bypass surgery and other heart surgeries. Surgeons perform more than 700,000 sternotomies each year in the United States.

What happens before a sternotomy?

Before your sternotomy, your healthcare provider will:

• Ask you to bathe or shower before coming to the hospital.
• Trim any hair on your chest, if needed.
• Give you antibiotics.
• Clean the skin on your chest and possibly beyond it, depending on the type of surgery.

How is a sternotomy done?

During your sternotomy, your surgeon will:

1. Cut through your skin with a scalpel, starting between your two collarbones. This is the top of your sternum. They’ll cut down to where your sternum ends. Your sternum is about 6 inches long if you’re an adult.
2. Cut through the middle of your sternum with a sternal saw from top to bottom.
3. Put in a tool (retractor) to move your split sternum apart.
4. Possibly remove part or all of your thymus gland if you’re a child (for better visibility).
5. Open your pericardium, the sac around your heart.
6. Access your heart through the opening in your pericardium.
7. Perform surgery on your heart or another body part in that area.
8. Close your sternum with eight to 12 sternotomy wires. If your bone is too hard for a needle to get through, your provider may use a drill to make small holes for the wires to go through.
9. Close your chest tissues and skin.
10. Put antibiotic ointment on your wound.

What are sternotomy wires?

Sternotomy wires are stainless steel wires your surgeon uses to hold the two halves of your sternum together after they complete the heart surgery. They usually don't remove the wires unless you:

• Have chronic pain or discomfort after surgery.
• Have an infection in that area.
• Need another surgery.

Can sternotomy wires break?

Yes, sternotomy wires can break if a surgeon tightens them too much.

What happens after a sternotomy procedure?

After your sternotomy, you’ll:

• Have fluid draining from your chest.
• Need to wear a bra 24 hours a day if you have more than a little breast tissue. This lifts your breasts’ weight off of your incision. You should wear this for one or two weeks after leaving the hospital.

How painful is a sternotomy?

Most people can just take acetaminophen and non-steroidal medicines for pain after their sternotomy. Some people need more powerful medicine for their pain.

What are the advantages of a sternotomy?

Advantages of a sternotomy include:

• It gives your surgeon very good access to your heart.
• Most people tolerate it well.
• It’s a fast and easy procedure to do.
• Complications don’t happen often.

What are the risks or complications of a sternotomy?

Risks of a sternotomy include:

• Infection.
• Bleeding.
• Abnormal heart rhythm.
• Swelling.

What is the recovery time?

It takes eight weeks for median sternotomy recovery. If you’re doing cardiac rehab after your heart surgery, you’ll need to limit how much you move your upper body while your sternum heals.

During your median sternotomy recovery:

• Don’t lift more than 10 pounds. This is a little more than a gallon of milk, which weighs eight pounds.
• Use both arms to lift things.
• Hold your arms close to your body when you lift something.

You’ll also need to follow your provider’s instructions for recovery from the surgery they performed after your sternotomy.

When can I go back to driving?

You should be able to drive again about a month after your surgery. While your sternum is healing, you should wear a seat belt and sit in the front passenger seat. Even if they may feel uncomfortable on your chest, a seat belt and airbag will protect you during a crash.

When should I see my healthcare provider?

You should have regular follow-up appointments with your healthcare provider.

After a sternotomy, you should contact your provider if your breastbone:

• Hurts.
• Moves.
• Cracks.
• Pops.
• Leaks fluid from your incision.

A note from Cleveland Clinic

Choosing the right approach for your heart surgery requires careful consideration of your situation and the procedure you’re having. Surgeons often choose a sternotomy because it’s the best way for them to see and reach your heart for certain procedures. If you have questions about a sternotomy and why it’s needed, don’t be afraid to ask your healthcare provider to explain.