Tony's surgeries in the cave: Part 3. Second Surgery
Why the second surgery was necessary: Part 1, Arrhythmia, Reactor, Part 2
Removal of the electromagnet.
Sternectomy - partial removal of Tony's sternum.
Removal of some chest and abdominal muscles (some partially, some completely).
Removal of parts of at least 4 ribs on both sides together with parts of attached muscles.
Yinsen may or may not have removed the thymus.
Tony's heart was slightly shifted back in his chest cavity.
Implantation of pacemaker-ICD electrodes running from the bottom of the reactor housing to the heart (This could be done either directly through the chest cavity outside the heart, or through the subclavian vein into the heart).
Removal of parts of Tony's lungs/lungs moved to the sides.
Displacement of blood vessels in Tony's chest.
Displacement or removal of lymph nodes in the chest. In case of removal - replacement with an artificial system connected to the reactor housing.
Implantation of the titanium reactor housing, its attachment to the parts of the sternum that were not removed.
Connecting the housing to the ribs using rib clamps.
Attaching the reactor with the pacemaker to the housing.
Suturing muscles and tendons to the reactor using surgical/biological mesh.
Closing the wound with polyester cuff around the housing where it meets the skin.
Suturing the sternectomy incision.
How do we know this actually happened?
In addition to the reasons stated in Part 1:
After the first surgery, we don't see the reactor housing in Tony's chest. The electromagnet is bolted to the sternum and, unlike the reactor, cannot simply be temporarily removed from the chest.
As you can see below, unlike the electromagnet, the reactor housing is complex, clean, made of titanium and designed specifically for the arc reactor.
Remember about internal organs - you can't just make a hole and put anything in there, no matter how deep it is. You'll need to remove or displace something.
In the scenes below we can see a fresh sternectomy scar after the reactor was implanted. The scar looks different every time, and sometimes it disappears completely thanks to makeup artists. There is not a single scene with this scar before the reactor.
As I mentioned in The Cave timeline (March 1 - April 12), several weeks passed between the successive scenes: Tony finished working on the reactor and showed Yinsen the armor blueprint > the security camera scene and the backgammon scene.
The two weeks between the first surgery and Tony waking up would not have been enough time to recover from the trauma of the reactor implantation. Tony instantly jumps to his feet and is able to raise his arms above his head and hold a car battery - nope, that's absolutely unrealistic.
The Ten Rings would not allow them not to work, but we see them playing board games. Post-op recovery explains it.
