“The world breaks everyone, and afterward, some are strong at the broken places.”
– Ernest Hemingway
As someone who has experienced open-heart surgery during a heart transplant, I know firsthand how daunting sternotomy recovery can feel. In this post, I’ll share practical advice for scar healing, overall recovery and rehabilitation after open heart surgery. I will address FAQs, some learned tips and tricks. Let’s unpack sternotomy precautions, including the “move within the tube” technique. All of which were a game-changer during my heart transplant recovery.
And the winner is…
I have recently been medically assessed for cardiomyopathy or constrictive pericarditis. You may have read my posts Understanding Constrictive Pericarditis and/or Cardiomyopathy, Hardening Of The Heart. I was being assessed for both cardiac conditions. This involved three hospital admissions. Each hospital admission was between 5 or 11 days. During this time I had every diagnostic test repeated. Tests included heart biopsies, heart catheter pressure testing, MRI, X-Ray and pathology. During the last admission the team added a barium swallow and lumbar puncture to the list of testing.
The transplant team convened at a multi-disciplinary meeting to make a decision. After all this testing over the last 3 months, the winner is Constrictive Pericarditis! Therefore, I am to have a Pericardiectomy.
A pericardiectomy is when the heart lining is completely or partially removed. This involves open heart surgery. I am therefore going to have a sternotomy, again. As such I thought it was a good time to write about recovering from a sternotomy. Knowing how to “Move Within The Tube” is essential to a full recovery.
What is the difference between a thoracotomy and a sternotomy?
The difference between a thoracotomy and a sternotomy is the incision point. If you have a thoracotomy, the surgeon makes the incision (cut) in between your ribs. If you have a sternotomy, the incision is through your sternum (breastbone).
What is a Sternotomy?
A sternotomy involves splitting the sternum (breastbone) to access the heart or surrounding structures. This procedure is common in operations like heart transplants, bypass surgery, or valve replacements. It’s a major operation that requires dedicated recovery time. Appropriate rehabilitation is also necessary.
Healing the breastbone takes approximately 6 – 12 weeks. Recovery is even longer for patients who have already had open heart surgery. However, how you move during this period can significantly impact your recovery.
The breast bone has been separated during surgery. Hence it is like any other broken bone that needs to knit and heal. This process takes time and requires precautions to protect the healing breast bone.
What Are Sternal Precautions?
Sternal precautions include a range of movement restrictions and adjustments. Essentially these precautions are designed to protect the sternum as it heals. These precautions minimise the risk of complications such as poor bone healing, infection, or dehiscence (wound reopening).
List Of Sternotomy Precautions
Avoid pushing or pulling through the arms
Limit elevation of the arms, where your elbows remain below shoulder height.
Avoid activities that cause you to strain.
Limit use of the arms when transferring from sitting to standing and when getting out of bed
Avoid unilateral (one sided) arm movements, move arms together.
Avoid lifting objects heavier than 2 kilograms (4.4 pounds).
When coughing, sneezing or moving, support your sternum with a sternum pillow or cushion. If a pillow is not available you can cross your arms in a self-hugging position.
Avoid placing the arms behind the back.
Wear a front opening bra.
Be patient, invest time in your recovery for long term quality of life.
Why do they give you a pillow after heart surgery?
Once you are awake after open heart surgery the ICU nurse will give you a small sternum pillow. The pillow offers support to the breast bone during coughing, sneezing or other strenuous movements. It prevents the breast bone jolting or moving. It may reduce pain and can help prevent injury to the wires holding the sternum in place as it heals.
For me this sternum pillow was a hospital towel folded and taped with surgical tape. There are little heart shaped or red pillows you can buy.
If you are going to spend money on a specially designed pillow ensure it can easily be washed. You may be on blood thinners after the surgery. I found that I continued to ooze blood around the surgery site. The drains, leads, and wires were also causing oozing on my torso. For this reason I used and replaced my folded towel often to avoid possible infection.
“Move Within The Tube”
What Is The “Move Within the Tube” Approach
The “move within the tube” concept encourages safe, controlled movement to protect the healing sternum. Imagine you have had your arms from the shoulder to elbow duct taped to the side of your body. This method replaces traditional restrictive sternal precautions with functional, guided motion, promoting faster recovery without compromising the breastbone.
Core Principles Of Move Within The Tube
Keep Arms Close to the Body: Imagine your arms are inside a cylinder or tube. Avoid wide-reaching movements.
Engage Both Arms: Use both hands equally to reduce asymmetrical pressure on the sternum.
Use Core Muscles: When getting out of bed or lifting, engage your abdominal muscles. Use your legs instead of relying solely on your arms. Only use your arms for balance.
Need a Visual?
View the YouTube clip where international consultants have a discussion on evidence-based recommendations for movement following sternotomy.
Goodbye Sternal Precautions, Hello Move in the Tube?
This clip provides a quick demonstration of how to move in the tube: Keep Your Move in the Tube
Examples of Safe Movements Post Open Heart Surgery
Getting out of bed: See the FAQ section.
Carrying objects: Keep items close to your chest, and avoid lifting anything over 2 kg.
Reaching: Keep elbow movements below shoulder height. Do not put your arms behind your back. Do not reach your arms above the elbow out to the side. Ideally both arms will move together identically. This means you lift your forearms up or down at the same time to avoid opposing movement.
Sternotomy FAQs
Can I feel my sternal wires?
Initially you will have pain due to the sternum being traumatised. However, you should not feel the wires through your skin. Unless you are very this the wires are unnoticeable other than via X-ray. or in any way after full recovery (3 to 6 months).
Do sternal wires set off airport security?
No. I have flown and attended concerts and sporting events. The security system did not pick up the wires at all. I asked security and they told me the system is set above that threshold.
How do I reduce sternotomy scarring?
This is a real issue for many patients. The scar is long and right in the center of your chest. The scar can be seen unless you are wearing high neck clothing. After a lot of research, expense and trial and error I found Strataderm was the most effective. Strataderm is a medical grade silicone. Silicone keeps the scar tissue hydrated. It assists in preventing a variety of scarring including keloid scarring. Keloid scars tend to become raised, thick and shiny.
What happens to breasts during open-heart surgery?
You still have them when you wake up! I promise you.
Breasts, depending on size are separated and held in place during the operation. After surgery you may have a urine catheter, pacing wires and drains attached to you. These make it difficult or even impossible to shower and wear clothes, undies and a bra.
Once these leads and drains are removed you will be able to shower and wear your own clothes. This may be 3 to 8 days after surgery and varies between patients.
Can I Wear A Bra after Open Heart Surgery?
The first 8 days post surgery I could not wear any undies or bra. I only wore a hospital gown. Actually I always use TWO gowns. Please ask for a second gown to wear. The first gown is worn with the opening at the back. The second gown is worn with the opening at the front. This way your bare backside is kept covered. Remember the OT’s will be getting you up out of bed and walking around the ward asap. I can’t tell you how many bottoms I have seen in the last 3 years during hospital admissions.
In the second week after surgery I was able to shower. I wore loose oversize comfortable clothing. The tops all had front openings. Instead of a bra I wore a bandeau bra which I could step into and pull up. The top and bottom bands on the bandeau bra are softer than a regular bra. As the scar healed I transitioned to a surgical bra with an opening at the front. Remember, you will not be able to put your arms behind your back to fasten a back closing bra.
Eventually you will be able to wear any bra you prefer. You must wait until the sternotomy scar and breast bone have completely healed.
How do you get out of bed after a sternotomy?
The OT’s will walk you through it. Essentially you will move close to the edge of the bed. Grab hold of your sternal pillow and hug it to your sternum. Then you roll onto your side. First, put your legs down off the bed. Drive your upper shoulder forward. Use the momentum to help you sit up. Keep your arms hugged across your chest and avoid using your arms or elbow.
This is a great clip: How to get in and out of bed after OPEN HEART surgery
Do you ever fully recover from open-heart surgery?
Generally YES. However, it does depend on why you required open heart surgery in the first instance. All surgical recovery is very individualised and determined by many factors. My husband had open heart surgery in 2019. He had the aortic valve replaced. He has fully recovered from the surgery. I had the heart transplant 19 months ago. Thankfully, I have full range of motion in my arms, back, and torso. I have no pain from the sternotomy.
How long do you have to sleep upright after open heart surgery?
This is a tricky question to answer. I found a variety of views on the topic of sleeping. The general consensus was to sleep on your back for the first 4 weeks post sternotomy. You may want to be elevated with a wedge pillow or nest of pillows. As the breast bone heals you can sleep as you like as long as you are not uncomfortable.
My Top Tips for Sternotomy Recovery
Be Kind to Yourself
Recovery is a marathon, not a sprint. Rest when needed, and don’t rush activities that strain your body.
Stay Safely Active
Our bodies are designed to move. The more sedentary we are the stiffer we become. Gentle walks were my lifeline. They improved circulation, lifted my mood, and gradually built strength. I started at home walking around the house. I transitioned to the treadmill and slowly built up time and speed. Eventually, I was able to do the flat easy bush track near home.
Use The Cardiac Rehab Program
These programs are offered by the hospital and are free. The programs are tailored to your recovery stage. I liked that my vital signs were being monitored as I exercised. It gave me peace of mind. Attending the program allows you to meet other patients and build a community.
Listen to Your Body
Pain is your body’s way of communicating. Adjust movements or activities if something feels wrong. Trust your instincts.
Advocate for Yourself
Ask questions, there are no silly questions. If in doubt, ask for a second opinion. Ensure you understand your care plan. Do not rely solely on your carer, this is your recovery. Have agency about your health and recovery. Self-advocacy is critical in maintaining your health and quality of life.
Sternotomy Recovery Challenges and Solutions
| Challenge | Solution |
| Pain and Discomfort | Follow prescribed medications and consider physical therapy. |
| Feeling Isolated | Connect with support groups or peers who have had similar experiences. |
| Fear of Movement | Practice safe motions like “move within the tube” to build confidence. |
| Sleep Issues | Use extra pillows to elevate your chest and make sleeping easier. |
It’s All About You
Our community wants to hear from you.
Have you experienced challenges with sternotomy recovery?
What role do you think self-advocacy plays in healing?
If you’ve used the “move within the tube” method, how did it change your recovery experience?
Please comment in the form below.
As always, Love and Light
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Wednesday
References
Australia, H. R. (2023, July 24). Exercise following open chest surgery. Heart Research Australia. https://www.heartresearch.com.au/exercise-following-open-chest-surgery/
Bilal, M., MRCS R. H. (n.d.). Sternotomy: Overview, preparation, technique. Medscape. Retrieved November 25, 2024, from https://emedicine.medscape.com/article/1894058-overview?form=fpf
British Heart Foundation. (n.d.). Wearing a bra after heart surgery. British Heart Foundation. Retrieved November 25, 2024, from https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/wearing-a-bra-after-heart-surgery
Heart surgery and recovery – Overview. (n.d.). Guy’s and St Thomas’ NHS Foundation Trust. Retrieved November 25, 2024, from https://www.guysandstthomas.nhs.uk/health-information/heart-surgery-and-recovery
Heart surgery and recovery resources. (2023, March 15). Www.Heart.Org. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/heart-surgery-resources
Homepage. (2022, February 14). The American Association for Thoracic Surgery | AATS. https://www.aats.org
Leading the fight to save Australian hearts. (n.d.). Heart Foundation. Retrieved November 25, 2024, from https://www.heartfoundation.org.au
Recovering from open-heart surgery: 6 things to expect. (n.d.). Retrieved November 25, 2024, from https://www.michiganmedicine.org/health-lab/recovering-open-heart-surgery-6-things-expect
Sternotomy precautions: What to expect at home. (n.d.). Retrieved November 25, 2024, from https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abo3138
-YouTube. (n.d.). Retrieved November 25, 2024, from https://www.youtube.com/watch?v=hbjA8ufoVZs
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