Cardiac surgeons have experienced many years of practice and mapping, and most now use a median sternal incision in most procedures. The advantages of this incision are good field exposure, low surgical risk, mild postoperative pain, and better maintenance of the thoracic shape. It can perform most complex cardiac surgeries. However, some patients develop a pectus excavatum or funnel chest after surgery. The small mid-axillary incision I highly recommend this incision, especially for simple precordial disease, atrial defects, small ventricular defects, and patent ductus arteriosus. The advantage is that there is little damage and little muscle incision, almost just the intercostal muscle. The incision is aesthetically pleasing, and with the arm down, it is not visible at all. The smallest ventricular defect I did had an incision of only 3.5 cm. Here is a picture of one of the children I did that was taken and sent to me 3 months after they went home. Arterial catheter incisions can be smaller, and the smallest one I did was 2.5 cm. But this type of incision is more demanding on the surgeon, who has to be very skilled in dissection and manipulation. When poorly exposed, it is difficult to operate in overly complex cases. Small lower sternal incision For simple precordial disease in boys, I recommend this incision. The damage is minimal, the pain is mild, the thorax is not deformed, and the scar is not revealed by low-cut clothing. The incision can be extended if complications arise. The length of this incision for my own surgery is usually 3-4 cm. The smallest one is 2.5 cm. The lateral anterior axillary incision is similar to the mid-axillary incision. It is a matter of opinion, but I personally do not recommend it much, mainly because the literature reports that it may affect the development of the breast. I once saw a girl whose incision was only 1-2 cm from the nipple, so it would have been better to make a median incision instead. There is also more muscle to be transected and slightly more damage. Small parasternal incisions are made mainly for specific conditions, such as the closure of atrial defects. The incision can be small, but if complications arise that require an extended incision, it can be more problematic and may affect the aesthetics of the breast. There are some other incisions that are not applied much and will not be described in detail here.