A sternotomy is a surgical cut through the breastbone (sternum) that gives surgeons direct access to the heart, major blood vessels, and lungs. It is the most common approach for open-heart surgery, used in procedures like coronary artery bypass grafting, heart valve replacement, and certain lung operations. The technique became standard in the 1950s and remains the primary way surgeons reach the chest cavity when they need a wide, unobstructed view of the organs inside.
Why Surgeons Use a Sternotomy
The sternum sits right in front of the heart, and splitting it down the middle creates the broadest possible opening into the chest. This matters when a surgeon needs to work on multiple coronary arteries, replace a valve, repair a congenital heart defect, or perform a heart or lung transplant. The approach is sometimes called a “median sternotomy” because the incision runs along the midline of the bone, from just below the notch at the base of your throat down toward your upper abdomen.
Minimally invasive alternatives do exist for some procedures. Aortic valve replacements, for instance, can sometimes be performed through a partial sternotomy (cutting only the upper portion of the bone) or a small incision between the ribs. These approaches use incisions of about 6 to 10 centimeters rather than opening the full length of the sternum. Studies comparing minimally invasive valve surgery to conventional sternotomy have found similar early outcomes, with mortality rates between 0.8% and 4% at experienced centers. Still, a full sternotomy remains necessary for many complex cardiac operations where the surgeon needs maximum visibility and access.
What Happens During the Procedure
After you’re under general anesthesia, the surgeon makes a vertical incision along the skin over the breastbone. A specialized oscillating saw then cuts through the sternum lengthwise. A retractor holds the two halves apart, exposing the area behind the breastbone (the mediastinum) where the heart and great vessels sit. The actual heart surgery then takes place, often with the help of a heart-lung bypass machine that temporarily does the work of your heart and lungs.
Once the cardiac procedure is complete, the surgeon brings the two halves of the sternum back together and secures them. The most common closure method uses stainless steel wires threaded through or around the bone, then twisted tight to hold the halves in place. These wires are permanent and generally stay in your body for life. Newer alternatives include rigid titanium plates, flat wire systems, and specialized clips. A meta-analysis of over 1,400 patients found that rigid plate fixation may lower the risk of sternal complications in high-risk patients compared to traditional wires, and it was associated with a shorter hospital stay in several studies. For most patients, however, standard wire closure works well.
Recovery Timeline
Bone healing after a sternotomy takes roughly eight weeks. During that period, the two halves of the sternum are knitting back together much like a fractured bone would. You’ll typically spend several days in the hospital after surgery, with the first day or two in an intensive care unit.
The weeks after discharge come with significant activity restrictions designed to protect the healing bone. Traditional sternal precautions vary by hospital but generally include lifting no more than 5 to 20 pounds for up to 12 weeks. You may also be told to avoid pushing yourself up from a seated position with your arms, reaching overhead, or making large movements with your shoulders. Some programs limit shoulder motions like raising your arms above your head or pulling your shoulder blades together. These restrictions can feel frustrating, but they reduce the force placed across the sternum while it fuses.
Full recovery, including a return to normal daily activities and exercise, typically takes two to three months. Some people feel close to normal sooner; others need longer, especially if complications arise or if they had limited fitness before surgery.
Pain After Surgery
Post-sternotomy pain is expected and usually most intense in the first few days. Hospitals typically manage it with a combination of approaches: local anesthetic injected near the incision, nerve blocks, anti-inflammatory medications, and stronger pain relievers when needed. The current standard is a multimodal strategy that layers different types of pain relief together, which tends to control discomfort more effectively than relying on any single method.
For most people, acute pain gradually decreases over the first several weeks. However, chronic pain lasting beyond three months is more common than many patients expect. One study comparing different types of open-heart surgery found that 75% to 88% of patients reported some degree of pain persisting past the three-month mark, depending on the specific procedure. This doesn’t necessarily mean severe pain. For many, it’s a dull ache, tightness, or sensitivity along the scar that slowly fades over months or even a year or two. If chest pain worsens rather than improves after the first few weeks, it could signal a complication and warrants attention.
Possible Complications
The most serious risk specific to sternotomy is a deep sternal wound infection, also called mediastinitis. This occurs in about 1% to 5% of patients and is considered life-threatening when it happens. A large review of over 8,000 sternotomies found an incidence of 1.5%. Risk factors include diabetes, obesity, chronic lung disease, osteoporosis, smoking, and prolonged time in the ICU after surgery.
Wound dehiscence, where the incision partially separates, is another concern. It tends to happen at the lower end of the incision and is more common in older patients, smokers, people with chronic lung disease, and obese women. Non-union of the bone, where the sternum fails to fuse properly, can cause persistent clicking, instability, or pain with movement.
The Scar
A sternotomy leaves a vertical scar running down the center of the chest, typically around 12 centimeters or longer depending on the procedure. In fair-skinned patients, the scar often heals as a thin line, though some degree of thickening (hypertrophy) is common over the portion covering the body of the sternum. Stretching of the scar tends to occur at the lower end, near the upper abdomen.
Keloid scarring, where the scar tissue grows beyond the original wound borders, is less common but can occur, particularly in people with a genetic tendency toward keloids. Treatment options for problem scars include silicone gel sheets, corticosteroid injections, pulsed dye laser treatment, and surgical excision. No single approach works reliably for everyone. In documented cases, surgical excision combined with post-operative steroid injections has shown the lowest recurrence rates, though treatment often involves trying less invasive options first.