Partial upper sternotomy for resection of a large substernal goiter in a high-risk patient

Substernal goiters (SGs) with significant mediastinal extension can present complex surgical dilemmas. While most SGs can be resected through a low cervical collar incision, a full median sternotomy may be required in select cases. Morbidly obese patients are susceptible to adverse outcomes following full sternotomy, such as wound infection and sternal dehiscence. Partial upper sternotomy is a safe, effective alternative that offers sufficient access to the mediastinum while minimizing surgical morbidity, making it a valuable approach in this high-risk population. We present the case of a 33-year-old female with a BMI of 47 kg/m2 who was found to have a large symptomatic SG with significant mediastinal extension. Due to the depth of extension, a combined cervical and trans-sternal approach was planned. A partial upper sternotomy was performed to avoid the morbidity of full sternotomy. The patient tolerated the procedure well without complications and was discharged home on postoperative day two.