Medical Oncologist
CION Cancer Clinics
What happens during a thymectomy | CION Cancer Clinics
A thymectomy removes the thymus, a small gland behind the breastbone, usually because of a thymoma or myasthenia gravis. You are fully asleep. The surgeon reaches the gland through the breastbone or through small cuts on the side of the chest, and most people spend a few days in hospital. This page walks through each stage, the risks, and what to ask your team. 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 a thymectomy, and why is it done?
- Which way will the surgeon reach the thymus?
- What happens from admission to going home?
- What can go wrong, and who is it not suited to?
- What do the words on the consent form and report mean?
- What do families often believe about this operation?
- What should you ask, and what can this page not tell you?
- Common questions about thymectomy
The short answer
What is a thymectomy, and why is it done?
A thymectomy is an operation to remove the thymus, a small gland that sits behind your breastbone and in front of your heart. It is done under a general anaesthetic, so you are fully asleep, and it usually means a few days in hospital.
Why the thymus is removed
The first is a tumour of the thymus, called a thymoma, or a rarer, faster-growing kind called thymic carcinoma. The second is myasthenia gravis, where the immune system weakens the muscles. In some people with it, removing the thymus helps the weakness over time.
What the surgeon takes out
The aim is to remove the whole thymus, the fat around it and any tumour in one piece, with its outer covering unbroken. If the tumour is stuck to something nearby, such as the lining around the heart or a small part of the lung, that may be removed too.
If you have myasthenia gravis, even mild, make sure the surgical team and the anaesthetist know before any date is fixed. It changes how the operation is planned.The approach
Which way will the surgeon reach the thymus?
The gland is the same. What changes is the route in. The choice depends on the size of the tumour, whether it has grown into nearby structures, and the experience of the team.
Through the breastbone
Called a median sternotomy. The breastbone is divided down the middle and wired back together at the end. It gives the widest view.
Often used for
- Large tumours
- Tumours pressing on or growing into blood vessels
Small cuts on the side of the chest
Called VATS, or video-assisted thoracoscopic surgery. A camera and long thin instruments go in between the ribs.
Often used for
- Smaller tumours that look contained
- Myasthenia gravis without a tumour
Robot-assisted
The same small cuts, but the instruments are held by robotic arms that the surgeon controls from a console. Not every centre has this, so ask your own centre directly.
Just below the breastbone
A single small cut under the lower tip of the breastbone. Fewer centres use it. It avoids cutting between the ribs.
Any keyhole approach can be changed to an open one during the operation if that is safer.Not sure whether this applies to you?
Ask an oncologistStep by step
What happens from admission to going home?
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Tests before the operation
A CT scan of the chest, blood tests, a heart tracing and often breathing tests. If you have myasthenia gravis, a neurologist checks that it is well controlled first.
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Fasting and medicines
You will be told when to stop eating and drinking. Bring every medicine you take. Do not stop any of them on your own; the surgeon and anaesthetist tell you what to take on the morning.
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In the operating theatre
You are put to sleep and a breathing tube is placed. The surgeon removes the thymus and tumour, checks for bleeding and places a thin chest drain to let fluid and air out.
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Waking up
Most people have the breathing tube taken out before they wake fully. You may spend the first night in an intensive care or high-dependency unit, where nurses watch your breathing closely.
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The first days on the ward
You are helped to walk early and shown breathing exercises. The drain comes out once it collects little fluid.
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Going home
Usually sooner after keyhole surgery than after a sternotomy. You get wound advice, pain relief and a date for the pathology result.
Being honest about risk
What can go wrong, and who is it not suited to?
Most people recover without a serious problem, but every chest operation carries risks. Your surgeon should talk you through the ones that apply to you before you sign the consent form.
The general risks
Bleeding, a wound or chest infection, a small air leak from the lung that keeps the drain in longer, and blood clots in the legs. After a sternotomy, the breastbone can rarely be slow to heal, which is more likely with diabetes or smoking.
Nerves that run close to the thymus
The nerve to one half of the breathing muscle, and the nerve to the voice box, both pass near the gland. If a tumour has grown around one, the surgeon may have to weigh removing the nerve against leaving tumour behind.
When surgery may not be the first step
If the tumour has spread widely, or has grown so far into major blood vessels that it cannot be removed safely, the team may suggest chemotherapy or radiotherapy first, or instead. Poor heart or lung health, or myasthenia gravis that is not yet controlled, can also mean waiting. Whether surgery is right for you is a decision for your treating team, with you.
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On your paperwork
What do the words on the consent form and report mean?
- Mediastinum
- The space in the middle of the chest, between the lungs, where the thymus, heart and major blood vessels sit.
- Extended thymectomy
- Removing the thymus together with the fat around it, where small pieces of thymus tissue can hide.
- Capsule
- The thin outer covering of a thymoma. Whether the tumour has broken through it is one of the most important things the report describes.
- Margin
- The edge of the tissue removed. A clear margin means no tumour cells were seen at that edge.
- Pericardium
- The thin bag around the heart. A piece of it is sometimes removed if the tumour is stuck to it.
- Chest drain
- A soft tube from the chest to a bottle or bag, draining fluid and air for the first few days.
Commonly believed
What do families often believe about this operation?
"Without the thymus, the immune system will stop working."
In adults, the thymus has already done most of its work, and much of it has turned into fat. The immune cells it trained stay in the body. Adults do not become unusually prone to infections after it is removed.
"Once the breastbone is cut, it will never be strong again."
The bone is wired back together and heals much like a broken bone. It needs protecting from heavy lifting for some weeks, but most people go back to normal daily life, and the wires usually stay in without causing trouble.
"A small cut means a small operation."
Keyhole surgery removes the same gland through smaller openings. The work inside the chest is similar, and so are the anaesthetic and the need for close watching afterwards.
"Once the tumour is out, the checks are over."
A thymoma can come back many years later, sometimes without symptoms. Follow-up scans over a long period are part of the plan, even when the operation went well.
Before you sign
What should you ask, and what can this page not tell you?
This page describes the operation in general. It cannot tell you which approach suits your tumour, how long your own stay will be, or what the final report will show. Those depend on your scans, your health and what the surgeon finds.
Questions worth taking with you
Which approach are you planning, and why? What would make you change to an open operation during surgery? Will a neurologist be involved? Is there any sign on the scan that nearby nerves or vessels are involved? Will I need radiotherapy afterwards, and who decides?
For the family member reading this
Go to the consultation if you can, and write the answers down. Ask the team who to call if breathing, swallowing or the wound worries you after discharge. If the person has myasthenia gravis, learn the early signs of a weakness flare before the operation date, not after.
Questions we are asked
Common questions about thymectomy
How long does a thymectomy take?
Usually a few hours in theatre, though the family waits longer because of anaesthetic preparation and the recovery room. A large tumour stuck to nearby structures takes longer than a small contained one. The surgeon can estimate more closely after seeing your scans.
How many days will I be in hospital?
After keyhole or robot-assisted surgery, many people go home within a few days. After a sternotomy the stay is usually longer. Myasthenia gravis, a slow air leak, or a need for more breathing support can extend it. Your team will not send you home until you are walking, eating and breathing comfortably.
Will it be very painful?
There will be pain, and the team works to keep it controlled with a drip, tablets or a numbing injection near the chest wall nerves. Tell the nurses early if pain stops you breathing deeply or coughing, because both matter for recovery.
Can I live a normal life without a thymus?
Yes, adults generally do. By adulthood the thymus has done most of its job and the immune cells it trained remain. What shapes life afterwards is the reason for the operation: the type of tumour, whether more treatment is needed, and how myasthenia gravis behaves if you have it.
When can I lift things and drive again?
After a sternotomy the breastbone needs time to knit, so heavy lifting and driving are held back for some weeks. After keyhole surgery it is usually sooner. Your surgeon will set the timing for your own wound. Lifting grandchildren counts as heavy lifting.
Will I need radiotherapy or chemotherapy afterwards?
Some people do. It depends on the type of tumour, whether it broke through its capsule, and whether the edges of the removed tissue were clear. The pathology report answers these, and the tumour board discusses it. Surgery for myasthenia gravis alone does not lead to cancer treatment.
Will the scar be obvious?
A sternotomy leaves a straight scar down the centre of the chest, which fades over months but stays visible. Keyhole and robot-assisted surgery leave a few small scars on the side of the chest. The approach is chosen for safety first, not for the scar.
Is thymectomy covered by Aarogyasri or insurance?
Often it is, when the operation is part of an approved treatment plan. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers can cover chest surgery, subject to their rules and pre-approval. Call the helpline with your card or policy details and the team will check your cover before admission.
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Sources
- National Cancer Institute — Thymoma and Thymic Carcinoma Treatment (PDQ) - Patient Version
- American Cancer Society — Thymus Cancer
- Cancer.Net — Thymoma
- NHS — Myasthenia gravis
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.
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