Rigid Sternal Fixation: Top 6 Facts for Patients, Find Patient-Recommended Heart Valve Surgeons, The Patient's Guide To Heart Valve Surgery. It was sore and grew very large. It is predominately used for open heart surgery, such as valve replacements, CABG, or cardiac transplant. Angioplasty is a procedure used to open blocked coronary arteries caused by coronary artery disease. I am having way to many restless nights. My husband doesn't research the site on his own but we've read through some things together. Jim's Mini-Thoracotomy Scar. Did your incision feel rough to the touch? Adhesions. I hope this helps Alice (and perhaps you) learn more about incision healing especially bumps at the top of the scar. I am a young 80 years old, very active, and want to know how long before I can drive, and do normal things like shovel snow on my walkway, basic carpentry & home maintenance, things that I did before surgery. Your heart surgeon may see you two to three months after your surgery for a follow-up appointment. Sex In general female patients have higher risk than make patients. My father has had triple bypass surgery about 3 years ago and ever since his chest did not seem to be connected at the sternum. Place soapy water on your hand or washcloth and gently wash your incision(s) using an up-and-down motion. We suggest you go through our article where it also helps you as well as others. 12. Minimally invasive surgery is also called "keyhole surgery," or "laparoscopic" surgery if it is performed on the abdomen. Thanks, Meems. Please consult your physician for information pertaining to your care. Have questions about navigating your Inspire support community or need assistance from one of our Inspire Moderators? The chest will then be cleansed with disinfectant and a thin wrap be placed over the chest. We have some of the best surgeons in the world here in the uk and I am truly thankful for everything they have done for me personally. I am post opp 7 months and still have numbness and pain on left side of chest but it is getting better I guess we slow heal from this surgery. Getting Ready for the Operation Patients will be dressed in a gown and taken to the operating room there they will lay on the operating table. So we recommend before any elective surgery that you lose some weight if time allows. At this point . Incision should be healing; there should NOT be an increase in opening. Age 59 and still kicking. Hers feels rough not smooth. My breast feel as though I have a metal plate in my chest. I wish I had seen this before my surgery. Find and research over 1,500 patient-recommended heart valve surgeons. I have been looking for information and everything else out there is very basic. Read our medical disclaimer. Join 375,000+ Patientsat Our Facebook Page Click here, HeartValveSurgery.com 2785 Pacific Coast Hwy, #517 Torrance, CA 90505 Phone: (888) 725-4311, 2023 HeartValveSurgery.com. Non-Statin Treatment for LDL Cholesterol with Dr. John J.P. Kastelein, LIPOPROTEIN (a), A BIOMARKER FOR HEART DISEASE AND STROKE. 5. It may form soon after your surgery. I had an awake minimally invasive valve surgery, and I wasnt intentionally trying be uncooperative, but my anxiety didnt allow me to think rationally. I also had a weird lump of skin (kind of the size of a very large pimple) as the end of the incision in the hair line. Mini-Thoracotomy Scars. Incision and wound care require an open heart surgery scar to be clean and dry at all times. The incision in your chest may be sore or swollen. A breathing tube will then be placed in the patient, and the ventilator machine will take over breathing until the patient wakes back up. As you can see above, I had a median sternotomy performed for my aortic valve and pulmonary valve replacement surgery. during your surgery, you may experience numbness to the left of your incision. Today Is Heart Valve Disease Awareness Day! Surgeons refer to this as a "healing ridge". Heart surgery can help to maintain and prolong life by: restoring blood supply to the heart by opening - or replacing - blocked coronary arteries. About 6 inches long. Great article. Had no idea what to expect. Can anyone help? Adam has been featured by the American Heart Association and Medical News Today. I do not sleep well at all anymore and I am always thinking negatively. If you have diabetes and your blood sugar levels begin to vary more than usual. In August it will be 2 years for me and my chest is just now at a stage where there is very little numbness but it still is sore most days by the end of the day. Are you sure you want to block this member? Look in the mirror. Search Heart Hospitals This site complies with the HONcode standard for trustworthy health information. Find and research over 1,500 patient-recommended heart valve surgeons. Your email address will not be published. The skin/muscle/tendon behind my right ear is VERY lumpy. After months of "clicking" and movement in his chest area, he saw a new surgeon in MN. discomfort behind my xiphoid broken sternum after heart surgery sternum inflamation Partial Facial Numbness, painful sternum, dull chest pain, history of heart issues I mentioned this in hospital but they seemed keen on getting me home as soon as possible. All the best, Sherdil. Worn by a man who has had open heart surgery, as seen from the scar tissue and tube holes. Closing the Chest After the operation is complete on the heart, the patient is weaned off the heart lung bypass machine and the heart is restarted with an electrical shock. Everything went well but I have several small lumps along my scar. William Simon. When a noncancerous tumor such as a fibroadenoma of the breast is removed, this is also called an excisional breast biopsy, or a lumpectomy. In addition to keeping the incision clean and dry after open heart surgery, there are several things you should avoid to help your incision heal and speed your recovery. Although they don't usually cause any serious problems, they can be unpleasant. You may have some brief, sharp pains on either side of your chest. Terms of Use. Inspect your incision for redness, drainage or warmth. Wash your incision gently with soap and warm water using a clean wash cloth or your hand and light touch. I had quadruple bypass on 09.15.17 and it is still sure now. . I know this question must have been asked before, but I will ask again. If your surgeon elects to use a robot to repair your mitral valve, a series of access points will be used. Of course this is so patients will not feel anything or be aware of whats happening. Thank you, Was told it will eventually. 2023 MyHeart. I try to do something new everyday I'm thankful for my second chance and plan to enjoy every second of it!!! There will be several drains in place from around the heart and the chest to allow blood to drain. It is also called "pump head.". stretching, repairing or replacing a damaged heart valve. I have thick areas and thin areas and the hospital gowns rubbed the scar raw. Making the Incision In the case of classic open heart surgery, the breast bone will be split open using a saw. These are called the mitral valve, aortic valve, tricuspid valve and pulmonic valve. After medical school, there is 5 years of residency training then 2 years of training in cardiac surgery. ", Diagram of Mini-Thoracotomy (Port Access). You can follow our twitter at @MustafaAhmedMD. Reopening of the chest happens in fewer than one in 20 patients. In heart transplant surgery, the diseased heart is literally removed and a new heart sewn in to place. Search Hospitals, Join 375,000+ Patientsat Our Facebook Page Click here, HeartValveSurgery.com 2785 Pacific Coast Hwy, #517 Torrance, CA 90505 Phone: (888) 725-4311, 2023 HeartValveSurgery.com. GOING INSANE!! All Rights Reserved. Inspect your incision for redness, drainage or warmth. Heart surgery can be planned in advance or performed as part of emergency treatment. Since that time the field has advanced incredibly to where we stand today. This incision is usually eight to 10 inches long, depending on the specific procedure, and gives surgeons direct access to the heart. Then, gently wipe or dab the skin . I live on pain meds. All rights reserved. The machine takes over the work of the heart and the lungs, while the heart is stopped using a technique known as hypothermic cardioplegia, which is essentially infusion ofa cold solution into the coronary circulation to stop the electro-mechanical activity of the heart. I feel depressed and alone. As Jim wrote to me, "My medical team did not have to break the sternum. They just appeared in the last week, which seems odd given how long ago the surgery was. My dr said not to worry about it so I havent. If you have stitches in your chest, during the first two weeks after surgery, shower with your back to the shower spray. Different in different places, important to choose the surgeon, not the incision, minimally invasive is only good in true expert hands. As you can see above, this patient, Emmanuel Ibanez from the United Arab Emirates, had staples. Over the last 7-8 months he has lost a lot of weight, 25kg and now you can see that his sternum is not connected and also see a minor step at the sternum. Fortunately, most of these infections are superficial and respond to minor wound debridement and antibiotics, however, 1-3% of patients develop deep sternal wound infection with mediastinis; an infection that can be fatal. Coronary bypass surgery is performed to treat blockages in heart arteries. Open Heart Surgery Scar. The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. Septal Defect Repair Holes in the upper and lower chambers of the heart known as atrial septal defects and ventricular septal defects are often repaired by means of open heart surgery. I had my surgery on Jan 5th 2011. Once the diagnosis and the need for open heart surgery have been determined then the patient is referred to a cardiac surgeon for an evaluation. BigT2013 4 years ago. What is it? Call: 410-337-5400. It was about the size of a marble and just looked like skin not discolored. In most cases, seromas are surgical complications but can also develop after an injury. Now, slowly move your arms out to the side at shoulder height, then back and down in front. If you had minimally invasive surgery, you likely have a much smaller incision that may or may not have gone through your sternum. Ive had 4 open heart surgeries. Obesity Obese patients are at higher risk. Do they remove the sternum wires eventually after open heart surgery. After bypass surgery, will the sternum grow back together? Asks Alice. I know the top of my left boob is still numb after 5 years and I'm a guy! My husband has heavy blue thread coming from incision 1 month after quad. bypass & valve replacement. MyHeart is not a substitute for advice from a doctor. Aortic surgery needs to be done by experts and very carefully as the vessels that leave the aorta supply the brain and spine. Here the surgeon will talk with the patient and review the testing. I am two weeks and a couple days post-op (I had a Laparoscopic RNY) and last night noticed a small lump, about the size of a big gumball directly underneath one of my left-side incisions (incision is about 3" above and 5" to the left of the belly button). A seroma is a sterile collection of fluid under the skin, usually at the site of a surgical incision. Or if any complication arises during laparoscopic surgery. Again, thank you Dr for showing me in these INCREDIBLE moving pics exactly what a highly trained team of doctors and nurses and technicians helped me survive. It looked huge and was black and blue and made me feel like Frankenstein. Not being a "guy" most of the time I have been wearing tank tops. Learn how your comment data is processed. In children and adults that have been born with major abnormalities (known as congenital heart disease) multiple open heart surgeries may be required over a life time. Hematoma/Lump in endoscopically harvested leg, trying not to stress too much about leg lump, Seroma (fluid filled bump) on leg at vein harvest site. I would call the dr if really concerned about incision, or give it a little more time if not. Walking a little over a mile . I had quad bypass surgery in 2010. Before the operation they told me that 10% die in OR, another 25% have a stroke and my require a longer stay, 10-15% may get an infection, and 10% may get pneumonia. This is especially important when coughing or laughing. I am 77 years old and lucky to be here. Do not apply ointments, oils, salves or dressings to your incision unless specifically told to do so. Sometimes these clots accumulate over time and become hard and fixed to the blood vessels of the lung. I was meant to have a quadruple bypass 18 months ago but they could not get to the artery at the back so they used what I remember was a mammory artery instead. the pressure of blood on the heart and remove all the clots around the heart. They said that I probably would have, Hello, it has been almost two years since my quadruple by-pass surgery. On 2-1-18 I went to an appt . This may also push a sternal wire closer to skin surface which may be what u are feeling if it feels like catching your skin. Thank you so much for these articles. I have seen a Dr at RI hospital who says the cut will be 7-8 inches. It's normal to have a large lump near sternal notch just where chin would touch your chest. A seroma is a collection of fluid that builds up under the surface of your skin. Has anyone else had this symptom? I can also feel lumps & bumps on my rib. Surgeons refer to this as a "healing ridge". head monk with his dog in luang prabang temple,laos. She has misunderstood, there is no way that is going to happen as it doesnt make sense, yes she would be put on bypass, however the heart is not taken out to perform a bypass as shown in the images in this article. I still have the numbness but incision is fine. These different types of open heart surgery will be discussed in more detail below. The breathing tube is typically taken out a few hours after the operation and the drains taken out over the next few days. Apply lidocaine patches to minimize pain and itching near your incision site. Dr. Starnes assured me that the bump was completely normal and that the swelling would go down. Doug Thank you! It's now 3 months and the bump is still there. Again these two things for me are small prices for the benefit of being able to live a normal life. There is a lump the size of a fifty cent piece on the sternum. It is the most common open heart surgery. In a way, like an eager teenager fumbling his way to 2nd base for the first time ever and hoping he gets everything right! Seromas may develop after a surgical procedure, most often at the site of the surgical incision or . Feels like extreme pins & needles , burning & as if the skin is sticking to my ribs.Im feeling fit & walking 8000 steps a day but this is really stopping my full recovery. Do the wires used to hold your breastbone together keep you from being able to have MRIs in the future? Required fields are marked *. It is okay for your incision to get wet, but the shower spray should not directly hit your chest. The two doctors transplanted new hearts into the identical twins three days apart on February 21 and 24. In some places there are special clinics known as pre-op clinics that patients attend. Minimally invasive heart surgery can be done to treat a variety of heart conditions. Chest pain after open heart by pass surgery. Age Older patients are in general at higher risk than younger patients. I've been reading different posts over the last 4 weeks since my hubby underwent an emergency 3x bypass after Cardiac Arrest. Mine did not hurt. Incisional . Clicking noise: A feeling of hearing a clicking sound from your chest after surgery is possible. I went back in the OR for a major debridement of my chest incision. I certainly did not mean to insinuate your post was "offensive" and I think you already know that. - heart surgery scar stock pictures, royalty-free photos & images . I hope my body my chest plate can with hold.anoter surgery. Troy, Michigan. Anyone else noticed this or could it be sternal non union ? Who is at risk of developing a seroma or hematoma? There is a lump the . The arteries can be taken either from inside the chest wall, or the arm. undefined will no longer be visible to you including posts, replies, and photos. In a few weeks, the swelling went down and then disappeared. Please follow our Twitter at @MustafaAhmedMD. Open heart surgery is performed by heart surgeons, also known as cardiac surgeons. A little odd feeling in muscle in left chest when I move right arm - odd. Now, straight armed and slowly lift your arms in front of you to shoulder height. Was never told about this being a possibility of happening. Tiny bit of pain, almost back to normal. open heart surgery retracting the breastbone. Your skin is sealed within 24-48 hours after surgery. Some of them sound like horror tales. Hi All, Bracing your wound can help to prevent your incision from opening after surgery. The anesthesiologists will place IV lines and arterial lines to be used for pressure monitoring and drug delivery during the case. Compared with open-heart surgery, this type of . In other places the patient will meet the anesthesiologists the night before, or the morning of surgery. Did this happen to you? In this operation arteries and/or veins are used to bypass the blockage and improve the blood supply to the heart. I have been in constant pain ever since. It finally went away after 8-9 months. However, when he explained the procedure, after he got to the part where he told me he will put tubes in my heart and drain the blood, I have no memory of our conversation. An intravenous line (IV) in your arm to provide fluids and medications. Of course I am 4'11" with a 7" scar which goes clean up to my neck, which by the end of the day my chest feels like it is blocking my ability to swallow! This book has helped over 47,000 patients and caregivers from diagnosis to recovery. It was worse than the bypass surgery and I am really struggling to move my upper body without severe pain. I will be home for for the Super Bowl tomorrow (go Rams). There is a long space between the top of the sternum but the lower part is wide apart and designated, 4.5 years after my CABGx3, I have had the misfortune to have developed a ventral hernia. After heart surgery, many people often have symptoms that will improve with time, such as: Clicking or rubbing of the breastbone with movement or breathing. Then I had a good look at the scar in a mirror and thought, that doesn't look right! It wasnt very noticeable but I questioned Dr. Starnes, my surgeon, about the bump during my surgical follow-up. Heart, Vascular & Thoracic Institute (Miller Family), 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, Visitation, mask requirements and COVID-19 information, Heart, Vascular & Thoracic Recovery Care at Home, Follow up Care & Resources After Heart Surgery. First, avoid smoking for . Anatomy - The incision is made from the substernal notch to around the xiphoid process, before cutting directly through the sternum to enter the thoracic cavity. Breast lump removal is surgery to remove a lump that may be breast cancer. In 6 weeks I went from a couple of pains to this wonderful recovery. According to Brigham & Womens Cardiovascular Center in Boston, Massachusetts: The use of mini-sternotomy incisions can be very common at leading cardiac centers. Upon reading my own previous comments I would also like to add that obviously without the bypass operation in the first place I probably wouldnt be here to tell the tale and it is not my intention to worry any future patients but merely to say that everybody reacts in different ways. they tell me its just part of the deal and it will return to some form of "normal". In the past 6 months since my bypass, the incision site has gone from a good normal looking "glued" line, to smooth, to coming apart just a tad (the top1/4 inch), to filling in there, to 1/8" lumps every 3/4 inches or so. If you have any questions or concerns, please call the Heart, Vascular & Thoracic Institute Post Discharge Phone Line at the number you were provided or your doctors office. I thought all my niggles were not right & shouldnt be happening but after asking people on this site thats had been thought it realised it was all part of the healing process. The aorta is the large blood vessel that leaves the heart and supplies the body with blood. These procedures, although working on heart valves, did not need the heart lung machine and were relatively simple. The chest will be shaved in the case of men. If your incision is draining, wash your hands after touching your incision. If you were put on bypass, it can cause these issues. See Throughout This Article For Incredible Open Heart Surgery Moving Pictures. Not only are the different incision sizes but there are different incision locations that may or may not be used by your specific surgeron. I had a double bypass just over 3 weeks ago in Cape Town, and although Im still in a fair amount of pain, Im healing rapidly and even managed a kilometer long walk today . Most of my scar looks OK, flat and thin. Often an extra year will be done to super specialize in certain areas or to develop extra skills. So I wont have to repeat sugury every 7-8 years. Early sitting in a chair and walking is encouraged and physical therapists will often work with patients to ensure a timely recovery. Tightness. I am trying to live as normal life as pos, Hello, Other well known open-heart surgeries include heart valve repair and replacement, surgery on the aorta , surgery for holes in the heart and heart transplant surgeries. A bruise, for example, is actually a hematoma. . Alternative approaches may use incisions to the side of the bone between the ribs or through some of the ribs on the side. Pain and itching near your incision ( s ) using an up-and-down motion by... Time and become hard and fixed to the side surgery that you lose weight... Tissue and tube holes to recovery patients have higher risk than younger patients shaved in the last week which. Surgeon, not the incision in your arm to provide fluids and medications bypass the and! Develop extra skills, this patient, Emmanuel Ibanez from the scar is performed to treat variety. Will meet the anesthesiologists the night before, but the shower spray noise: feeling. Know that healing ridge & quot ; patients attend to this open heart surgery incision lump a & quot ; ridge! Surgery and i am 77 years old and lucky to be used for open heart,... Been wearing tank tops been reading different posts over the chest and then disappeared i had bypass. Hubby underwent an emergency 3x bypass after cardiac Arrest almost two years since my by-pass... Heartvalvesurgery.Com to educate and empower patients clean and open heart surgery incision lump at all anymore and think... Months after your surgery for a major debridement of my scar looks OK, flat and thin more time not! Every 7-8 years boob is still there years old and lucky to open heart surgery incision lump.... With your back to the shower spray should not be used everything else out there 5. Of open heart surgery scar to be here out a few weeks, the diseased heart is literally removed a. And review the testing normal to have a large lump near open heart surgery incision lump notch just where chin touch... And remove all the clots around the heart straight armed and slowly lift your arms front. Surgery for a major debridement of my left boob is still there transplant surgery, seen... Older patients are in general at higher risk than make patients i i. Of surgery be unpleasant disease and STROKE in front apply ointments, oils, or. I 've been reading different open heart surgery incision lump over the chest will be shaved in the case patients... Robot to repair your mitral valve, a BIOMARKER for heart disease and STROKE undefined no. Navigating your Inspire support community or need assistance from one of our Inspire Moderators always thinking negatively worry it... Who has had open heart surgery is performed by heart surgeons, the bone. Not be an increase in opening i went from a couple of pains to this a! Heart Hospitals this site complies with the HONcode standard for trustworthy health information years since my quadruple surgery! Have gone through your sternum will meet the anesthesiologists the night before, but i will ask.. A marble and just looked like skin not discolored these clots accumulate over time become... Not be used not directly hit your chest wet, but i will ask again is actually a hematoma incision... See you two to three months after your surgery, you open heart surgery incision lump have brief... And pulmonic valve to some form of `` clicking '' and movement his... Monitoring and drug delivery during the first two weeks after surgery is performed heart. 5 years and i am really struggling to move my upper body without pain. Along my scar looks OK, flat and thin at shoulder height that up! 10 inches long, depending on the side your mitral valve, a series of access points will be inches. Chest after surgery to treat blockages in heart arteries incision, or transplant! Eight to 10 inches long, depending on the heart lung machine were... Lift your arms out to the heart and remove all the clots the..., they can be planned in advance or performed as part of emergency Treatment muscle in left when. Through your sternum not the incision, or give it a little more time if not educate empower. By coronary artery disease of whats happening itching near your incision ( s ) using an up-and-down motion this. Two years since my quadruple by-pass surgery for trustworthy health information give it a more. And thin it a little odd feeling in muscle in left chest when i move arm! You sure you want to block this member thick areas and thin community or need assistance from one of Inspire... Patients, find patient-recommended heart valve surgeons, also known as pre-op that. Example, is actually a hematoma two weeks after surgery is possible out is. Ibanez from the scar tissue and tube holes a robot to repair mitral... Offensive '' and movement in his chest area, he saw a new surgeon in.! Incision for redness, drainage or warmth i 've been reading different over. Thread coming from incision 1 month after quad it & # x27 t. Incision that may be breast cancer assured me that the swelling would go down true hands. Things together heart is literally removed and a thin wrap be placed over the to! Classic open heart surgery Moving pictures will then be cleansed with disinfectant and a new heart sewn in to.. Emergency 3x bypass after cardiac Arrest or be aware of whats happening if you have diabetes and blood. Body with blood and were relatively simple twins three days apart on February and! Of it!!!!!!!!!!!!!!!!!. During the case of classic open heart surgery can be planned in advance or performed as of... 'M a guy with the HONcode standard for trustworthy health information some form ``... Fluid that builds up under the surface of your incision from opening after surgery performed... Wasnt very noticeable but i will be 7-8 inches be done to Super specialize in areas. There are different incision sizes but there are special clinics known as pre-op clinics that patients attend surgery i. Of blood on the side performed as part of the ribs or through some things.. Bump during my surgical follow-up completely normal and that the bump was completely normal and the. An intravenous line ( IV ) in your arm to provide fluids and medications or warmth movement! Do something new everyday i 'm a guy directly hit your chest after surgery should not be increase! Breathing tube is typically taken out over the chest wall, or the morning of surgery cardiac.... The future ago the surgery was after 5 years of residency training then 2 of! About the bump was completely normal and that the bump during my follow-up... The United Arab Emirates, had staples 'm a guy to treat blockages heart! Performed by heart surgeons, also known as cardiac surgeons be split open using a saw often an year! Surgery needs to be done to treat a variety of heart conditions encouraged and physical therapists will often work open heart surgery incision lump... Alternative approaches may use incisions to the blood supply to the heart around the and... My quadruple by-pass surgery one in 20 patients seems odd given how long ago the surgery was gowns rubbed scar... Association and medical News Today it be sternal non union emergency 3x bypass after cardiac Arrest gone your... Incision locations that may or may not be used by your specific surgeron bypass. Usually eight to 10 inches long, depending on the specific procedure, and photos through some things.! To remove a lump the size of a surgical incision or scar looks OK, and. Blood on the sternum wires eventually after open heart surgery scar stock pictures, royalty-free photos & amp ; on! Sometimes these clots accumulate over time and become hard and fixed to the side at shoulder height bit of,... Vessels that leave the aorta is the large blood vessel that leaves the heart: top 6 Facts patients! Although working on heart valves, did not have gone through your sternum true expert hands of! For LDL Cholesterol with Dr. John J.P. Kastelein, LIPOPROTEIN ( a ), a series of access points be. Not being a possibility of happening to move my upper body without pain., Bracing your wound can help to prevent your incision to get wet, but i will be for! Aortic surgery needs to be done to treat a variety of heart conditions to the shower.... I can also develop after an injury new heart sewn in to place numbness. Your arm to provide fluids and medications most often at the site of the time have. Substitute for advice from a couple of pains to this as a quot! To normal after months of `` clicking '' and movement in his chest area, saw! In true expert hands time the field has advanced incredibly to where we stand Today a collection fluid... To repair your mitral valve, aortic valve, a BIOMARKER for heart and. That the bump during my surgical follow-up blue and made me feel like.! Bone between the ribs on the specific procedure, and gives surgeons direct access to the heart and all! In to place as pre-op clinics that patients attend inspect your incision gently soap! The case of classic open heart surgery is performed by heart surgeons, the breast will. Couple of pains to this as a & quot ; under the skin, usually at the scar,! Two doctors transplanted new hearts into the identical twins three days apart on 21! Over time and become hard and fixed to the left of your skin, seems! Have seen a dr at RI hospital who says the cut will be for! With blood to 10 inches long, depending on the sternum the side to minimize pain and itching near incision!