Background To evaluate the preoperative radiologic characteristics of the sternum and ribs in patients undergoing minimally invasive CBG and determine their implications for surgical access. Methods This prospective observational study was conducted at Bacha Khan Medical College, Mardan, and its affiliated hospital from January 2023 to January 2024. A total of 81 patients scheduled for minimally invasive CBG underwent high-resolution computed tomography of the thorax. Measurements included sternal length, width, thickness, angulation, rib spacing, rib thickness, cartilage calcification, skin-to sternum distance, internal thoracic artery proximity, and anatomical variants. Data were analyzed using SPSS version 26, with p<0.05 considered significant. Results The mean sternal length was 174.8 ± 12.5 mm, significantly greater in males (179.6 mm) than females (167.1 mm, p<0.001). Rib thickness and intercostal space width were also greater in males, while females had significantly higher skin-to-sternum distances (25.3 mm vs. 22.1 mm, p=0.002). Costal cartilage calcification was present in 43.2% of patients, increasing with age. Anatomical variants were rare (3.7%) and did not necessitate surgical approach change in most cases. Conclusion Preoperative radiologic assessment identifies key anatomical differences that may affect the feasibility of minimally invasive CBG. Males generally present more favorable chest wall dimensions for access, while greater soft tissue thickness in females may increase technical difficulty. Incorporating detailed chest wall morphometry into preoperative planning can improve surgical outcomes.