Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Hernia Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
In short
- The cut for heart surgery ends just above the belly. A hernia can form at its lower end, where the scar meets soft muscle.
- Not every lump there is a hernia. The tip of the breastbone or the end of a wire can stand out and feel like one.
- A planned repair waits until the breastbone has healed and the heart doctor agrees, which is usually some months after the heart operation.
The bypass or valve operation went well. Now there is a soft bulge just below the breastbone, where the scar ends.
It can be a hernia. It can also be something harmless. Here is how to tell, and what happens next.
Why a hernia forms there
Most heart operations are done through a cut down the middle of the breastbone. The lower end of that cut runs a short way into the upper belly.
Below the bone, the wall is only muscle and a thin sheet of tissue. If it does not knit firmly, a gap opens and fat pushes through.
Tubes that drained the chest often came out just below the breastbone too. A small hernia can form at those holes.
Things that feel like a hernia
The lowest tip of the breastbone sticks out in many people. After surgery it can suddenly be noticed.
The ends of the wires that hold the bone together can be felt under thin skin. Scar tissue can also form a firm ridge.
A hernia is soft. It grows when you cough or sit up, and often shrinks when you lie down.
A lump below the breastbone after heart surgery
| What you notice | What it is likely to be | What is done |
|---|---|---|
| Soft bulge that grows on coughing | A hernia at the end of the scar | Examination, then a scan |
| Small bulge where a tube came out | A drain site hernia | Examination, often a small repair |
| Hard point that never changes | The tip of the breastbone | Nothing, once confirmed |
| Sharp spot under the skin | The end of a wire | Heart team review |
| Redness, warmth or discharge | Wound or wire infection | Heart team review first |
Noticed a bulge at the bottom of your heart surgery scar? Bring your cardiac discharge summary and medicine list.
When it can be repaired
The breastbone takes about three months to heal. Lifting and straining are limited in that time anyway.
A small hernia that causes no trouble is usually watched until the heart doctor is happy. A painful lump that will not go back is seen the same day.
Blood thinners and the heart team
After a new valve or a stent, you may be on strong blood thinners. They are never stopped without the heart doctor.
The heart doctor and the hernia surgeon agree a plan together. Some medicines continue. Others are paused for a few days, sometimes with an injection in their place.
How the repair is done
A very small gap may be closed with stitches. A larger one is supported with mesh.
It can be done by open or keyhole surgery. The breastbone and its wires are left alone.
Bring your cardiac discharge summary and the latest echo report. They tell the team how well the heart pumps now.
Frequently asked questions
Is a bulge below the breastbone after bypass surgery a hernia?
It can be. It may also be the tip of the breastbone or a wire end. An examination tells them apart.
How soon after heart surgery can a hernia be repaired?
Usually after the breastbone has healed, about three months, and once the heart doctor agrees.
Do I have to stop my blood thinners for the repair?
Only as your heart doctor decides. Some continue, and some are paused for a few days.
Will the repair disturb the wires in my breastbone?
No. The repair is in the muscle below the bone. The breastbone and its wires are left alone.
Related pages
The main page on this site is hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Bring your reports. Second opinions are welcome.