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.

Female medical provider sitting at a table with a patient, explaining what a sternotomy is and its

Types of sternotomy

There are a few different types of sternotomy based on the exact location and size of the incision during your surgery. A median sternotomy is used in the majority of sternotomy surgeries today. Other options include mini sternotomy and clamshell sternotomy. The type of sternotomy that’s right for you will depend on your specific condition and your treatment goals.

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.

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:

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
Woman in a hospital bed wearing a hospital gown, smiling off-camera while preparing for sternotomy

The sternotomy procedure

Your care team will answer your questions and tell you what to expect at every step of your sternotomy procedure. Most last several hours and your care team will keep your loved ones informed while you are in the operating room. After surgery, you can expect to stay in the hospital for seven to 10 days.

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.

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.

Some risk of sternotomy include:

  • Anesthesia side effects, including nausea or headache
  • Persistent pain
  • Infections, including pneumonia
  • Excessive bleeding
  • Breastbone separation or instability
  • Abnormal heart rhythm or palpitations
  • Problems with the nerves in the arm and hand

Frequently asked questions