ASD repair/sternum healing

6year old female had open heart surgery to repair ASD and mitral valve.  Was returned to surgery about 48 hours after first surgery for complication and they had to reopen chest.  Everything is fine now, she is healthy and back to normal activity.  Her incision is only about 4 inches long, however, the sternum is quite obviously "bowed" outward.  You can feel it by touching if she is wearing something thin you can see that it is bowed outward.  There is no pain, no bruising, etc. that we were told to watch for. Is this normal for the sternum to bow out...will it flatten with age and growth?  thanks!

[Marie M Gleason, M.D.]

When a median sternotomy is performed and the breast-bone is sawed down the middle to expose the heart, it requires wires to hold it together for healing after the surgery is completed.  It is not uncommon for the breastbone to heal like the keel of a ship and stick out (called a pectus carinatum).  More often it heals so that the chest appears "sunken" (pectus excavatum).  Only time will tell if the protruding part of the sternum will get somewhat flatter, but often it does not.  As long as your cardiologist feels that the sternum is "stable" (the edges are healed together), then this is generally a cosmetic issue that is not treated, and usually causes no discomfort.