The sternotomy is a surgical procedure that often precedes heart surgery, and gives direct access to the heart. It is an incision in the chest that begins at the top of the sternum, which is the bone right below the neck’s hollow, and that runs down the middle of the chest to the end of the sternum. After the initial incision, surgeons crack the chest or cut through the sternum with a sternal saw to make sufficient room for surgery. Though not all surgeries require a sternotomy and there are alternatives in some cases, many surgeons still find this the best method for visualizing and repairing the heart.
There can be differences in the way a sternotomy is performed. A smaller or modified incision might be shorter in length and not progress the full way down the sternum. People can discuss with doctors what incision is most appropriate.
Many people are most concerned with the pain sternotomies might cause. Generally, when performed, a person is under anesthesia and won’t feel any part of it. After surgery, the patient can expect mild discomfort, which may worsen when they raise their arms above the head. Wearing soft support bras, like sports bras, especially helps women to minimize breast pull against the incision. For infants having surgery, parents need to be instructed not to pick up a child from under the arms until at least six weeks after the surgery.
It should be understood that a sternotomy, despite the fact that it splits bone, is usually less painful than people expect, providing no infection develops at the sternum. The area above the sternum doesn’t have a great deal of muscle to divide, so less pain may be associated with the incision line than people imagine. Some of the alternative access methods to the heart, such as going through one of the ribs to minimize scarring are often considered more painful than having an incision down the middle of the chest.
Another area of concern for people is what happens when the chest is cracked. After heart surgery takes place, the broken sternum is wired and the incision is closed with stitches or a combination of stitches and other adhesives. There are seldom complications of wiring and most people don’t ever feel the wires. In rare instances, a chest wire loosens years after the surgery and can poke the skin. A very simple removal surgery of the wire can be done to eliminate the issue.
Most people who have this procedure can expect some scarring as a result. Some people swear by use of scar creams to minimize scar appearance. Scars are still likely to be noted when people wear any type of shirt or other clothing that reveals the sternum. Even with a modified approach, a large part of the scar could be evident. An infant’s scars may have best chance of healing because very young skin is resilient. A sternotomy scar could be very light and unnoticeable, especially in adults who had surgery as babies.