Chest Wall Resection and Reconstruction

A chest wall resection is a type of open-surgery (large incisions of 8-10 inches long / involves dividing the breast bone / general anesthesia) performed to remove all or part of soft tissue, cartilage, sternum and/or ribs. Chest wall resections are most commonly performed for tumors, infection, radiation necrosis, and trauma.

A chest wall reconstruction, also a type of open-surgery procedure, uses artificial bone or titanium rib plating, as a way to help rebuild the skeletal structure of your chest wall after chest wall resection. The decision to perform a reconstruction of the chest wall after resection will depend on the specific part affected, if there’s any cosmetic concern, or if there’s a possibility of respiratory failure.

How to Prepare for Chest Wall Resection and Reconstruction Surgery

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before Chest Wall Resection and Reconstruction Surgery

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests, including:

• Blood tests
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Positon-emission tomography (PET)
• X-Rays

What to Expect During Chest Wall Resection and Reconstruction Surgery

Chest wall resection and reconstruction will typically take 3 hours to complete. This procedure is typically performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, your doctor will administer general anesthesia (make you feel sleepy).
• Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• The procedure requires your doctor to remove the area of the tumor on the chest wall.
• Removal of ribs may be needed depending on the size and location of the tumor.
• The area of the chest wall removed may need to be reconstructed with biologix or other materials to either improve the function or your chest wall or for cosmetic reasons.
• Once this is complete, the doctor will remove all instruments, close all incisions and you will be moved to the recovery area.

What to Expect After Chest Wall Resection and Reconstruction Surgery

After the surgery, you will be taken to the recovery step down unit. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 72 hours.
• You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
• Receive several different medicines to relieve pain. Patients will be given long-acting oral pain medication, NSAIDS, IV pain medication and multi-level intercostal nerve blocks.
• Your doctor will give you instructions to follow during your recovery.