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What is removed in a chest wall resection | CION Cancer Clinics
A chest wall resection removes the part of the chest wall a tumour has grown into, plus a rim of healthy tissue around it so that no cancer cells are left at the edge. Depending on how deep the tumour goes, that can mean skin, muscle, one or more ribs, part of the breastbone, or a small wedge of lung. This page explains each layer, what happens in theatre, and what only your own team can tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is actually removed in a chest wall resection?
- Which parts of the chest wall can be taken?
- What happens during the operation, in order
- Words you will see on the operation note, explained
- Four things families ask us, and what is actually true
- Who this operation does not suit, and what this page cannot tell you
- Common questions about what is removed in chest wall surgery
The short answer
What is actually removed in a chest wall resection?
A chest wall resection removes the part of the chest wall that a tumour has grown into, together with a rim of healthy tissue around it. That can mean skin, muscle, one or more ribs, part of the breastbone, and sometimes the thin lining under the ribs or the edge of the lung.
Why a rim of healthy tissue is taken
The surgeon is not trying to shave the tumour off. The aim is to lift it out in one piece with a margin, which means a border of normal tissue all the way round. The pathologist then checks that border under the microscope. A clear margin means no cancer cells were found at the edge.
Why the amount removed differs so much between people
Two people with the same diagnosis can have very different operations. It depends on how deep the tumour has gone and which layers it touches. A tumour that has only reached the muscle needs far less removed than one that has grown through the ribs and is pressing on the lung.
Your surgeon can only tell you what is planned. What is finally removed is confirmed during the operation and in the pathology report afterwards.Layer by layer
Which parts of the chest wall can be taken?
The chest wall is built in layers. Your operation may involve one of these or several of them together.
Skin and fat
Removed when the tumour has grown out to the surface, or when the skin over it has broken down. A large skin gap is closed with a flap of tissue moved from nearby.
Muscle
The muscles of the chest and back lie over the ribs. When a tumour involves them, the affected part is removed. Losing part of a muscle rarely stops you using the arm, though it can feel weaker at first.
Ribs and rib cartilage
Whole ribs or segments of rib are removed when the tumour has reached bone. At the front of the chest the soft cartilage joining the ribs to the breastbone is often taken with them.
Breastbone (sternum)
Part or all of the breastbone is removed when the tumour sits in it. This is less common and almost always needs a firm reconstruction, because the breastbone holds the front of the chest steady.
The inner lining, and the edge of the lung
Under the ribs is a thin lining called the pleura. A tumour that has crossed it may be stuck to the lung, and a wedge of lung is then removed in the same operation.
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What happens during the operation, in order
Marking and the cut
Under general anaesthetic, the surgeon marks the tumour and the planned margin on the skin using your scans. The cut is made wide enough to see the whole area and any tissue the tumour touches.
Freeing the block
The tumour, the layers it involves and the margin around it are freed as one block. Ribs are cut cleanly above and below the tumour, and the small vessels and nerves that run under each rib are tied off.
Checking the edges
In some cases a sliver from the edge is sent to the laboratory during the operation for a quick look under the microscope. If cancer cells are seen at the edge, the surgeon takes a little more.
Rebuilding and closing
If the gap is large or sits where the chest needs to stay firm, it is bridged with a mesh, a plate or a flap of your own tissue. A drain is usually left in, and the wound is closed in layers.
On your discharge summary
Words you will see on the operation note, explained
- En bloc
- Removed in one piece, without cutting through the tumour itself. This is the standard way a chest wall tumour is taken out.
- Margin
- The rim of healthy tissue around the tumour. "Clear" or "negative" means no cancer cells at the edge. "Involved" or "positive" means cells were found there.
- Wedge resection of lung
- A small triangular piece of lung was removed because the tumour was stuck to it. The rest of that lung stays.
- Prosthetic reconstruction
- The gap was bridged with a man-made material such as mesh or a plate rather than with your own tissue.
- Frozen section
- A quick microscope check of the edges done while you were still asleep, so the surgeon could take more if needed.
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Commonly believed
Four things families ask us, and what is actually true
"If ribs are removed, there will be a hole in the chest."
There is never an open hole. The gap is covered by the layers that remain, and where those are not enough it is bridged with mesh, a plate or a flap of muscle. From the outside the chest is closed and covered by skin.
"They will remove the whole lung as well."
Usually not. If the tumour is stuck to the lung, only a small wedge of lung is taken. Removing a whole lung is a separate, much bigger operation that is planned for different reasons and discussed with you well in advance.
"The surgeon will take as little as possible so recovery is quicker."
Taking less than the tumour needs is the one thing that makes a second operation likely. A slightly larger operation with clear edges is usually easier on you than two smaller ones.
"Once the tumour is out, no other treatment is needed."
Sometimes that is true. Often it is not. Depending on the type of tumour and what the pathology report shows at the edges, your team may recommend radiotherapy or chemotherapy afterwards. The operation is one part of a plan, not the whole plan.
!
After you go home, one thing that cannot wait
Sudden breathlessness, a part of the chest that seems to sink in when you breathe in, a fever with shivering, or a wound that becomes red, hot and leaks fluid. Any of these needs the same day, at the nearest emergency department or the hospital where you had the operation. Say that you have had chest wall surgery. Do not wait for the next clinic appointment.
Being straight with you
Who this operation does not suit, and what this page cannot tell you
A chest wall resection is not offered to everyone with a chest wall tumour. It is a large operation, and your team will weigh the size of the tumour, whether it has spread elsewhere, how well your heart and lungs are working, and whether the gap it leaves can be rebuilt safely.
When the team may advise against it
If the cancer has already spread to distant parts of the body, removing the chest wall tumour on its own rarely changes the course of the illness, and other treatments are usually discussed first. If your breathing reserve is poor, losing part of the chest wall may leave you more breathless than the tumour does. The decision belongs to you and your treating team.
What this page cannot tell you
It cannot tell you which layers will be removed in your case, whether your margin will be clear, or whether you will need treatment afterwards. Those answers come from your scans, your biopsy and the tumour board. Bring your reports and the family member who will help you decide.
Useful questions to ask: which layers do you expect to remove, will the gap need rebuilding, and what happens if the edge is not clear?Questions we are asked
Common questions about what is removed in chest wall surgery
Will my chest look different afterwards?
There will be a scar, and the area may look slightly flatter than the other side, especially if muscle or several ribs were removed. Under clothing most people find the change is not noticeable to others. If a flap was used, there is a second scar where the tissue came from.
Do the ribs grow back?
No. Bone that is removed does not regrow. That is why a larger gap is bridged with mesh, a plate or a flap. Over the following months scar tissue firms up around the repair and the chest becomes steady again.
Will the surgeon know exactly what to remove before the operation?
The plan comes from your CT and often a PET-CT or MRI, so the surgeon has a clear picture. Even so, the final decision on the margin is made during the operation, when the tissue can be seen and felt. Ask what might change on the day.
Is the tumour sent for testing after it is removed?
Yes, always. The whole block goes to the pathology laboratory, where the type of tumour is confirmed and every edge is checked for cancer cells. That report usually takes about a week and it shapes what, if anything, comes next. Ask for a copy.
Can part of the lung really be removed in the same operation?
Yes, if the tumour is stuck to it. A small wedge is taken along with the chest wall so that nothing is cut through. Most people do not notice a difference in breathing from losing a wedge, though you may stay in hospital a little longer.
What if the margin is not clear?
Your team will discuss it at the tumour board. The options are usually radiotherapy to the area, a second operation to take more tissue, or watching closely, depending on the type of tumour and where the involved edge is. It is a reason to plan the next step, not a sign the operation failed.
Is this the same as a mastectomy for breast cancer?
No. A mastectomy removes breast tissue and sometimes the skin over it. A chest wall resection goes deeper, into muscle, rib or breastbone, and is done only when a cancer has grown into those layers. Most people with breast cancer never need the deeper operation.
Can I ask for less to be removed?
You can always ask, and the surgeon should explain why each layer is being taken. The amount is set by where the tumour is, not by preference. Removing less than the margin needs makes it more likely that cancer cells are left behind.
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Dr. Muralidhar Muddusetty
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Dr. Vinay Mamidala
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Sources
- Cancer Research UK — Surgery for cancer
- National Cancer Institute — Surgery to Treat Cancer
- Macmillan Cancer Support — Surgery
- American Cancer Society — Cancer Surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Rib Resection and How Many Can Be RemovedWhat decides how many ribs are takenChest Wall Reconstruction: Mesh and FlapsHow the gap is rebuilt after the tumour is outWhich Tumours Involve the Chest WallThe cancers that lead to this operationThe Pathology Report After SurgeryWhat margin and grade mean on the reportDeciding on Cancer SurgeryWhat the team weighs and what to ask
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