Teen cousins with same condition get surgery at Sanford

'Nuss procedure' took Carter and Ryan's concave chests and gave them confidence

Two teen Sanford Health patients sit on a couch and smile for the camera.

Cousins Carter and Ryan Sveeggen love playing football.

They love playing basketball.

And, they love being active.

But for the past year, they couldn’t.

Both were born with a concave chest, or a pectus excavatum.

Pectus excavatum, explained

Jon Ryckman, M.D. is the chief of pediatric surgery and chief of staff for Sanford Children’s Specialty Clinic in Sioux Falls, South Dakota.

He said, in layman’s terms, a concave chest is “a funnel chest,” meaning there’s a depression of the bottom of the sternum.

“If that happens, it can cause issues with the way the heart and lungs can function. It can push the heart to one side or the other and affect the way the heart fills up. Especially during times of exercise or stress,” he explained.

Family-focused surgery: Pediatric surgery at Sanford Health

Dr. Ryckman says it’s common. In fact, most people are born with it.

“It can be very mild at birth. You don’t always notice it. It tends to progress during growth spurts. It doesn’t always get worse, but it can during the teenage years and during puberty. That’s when we often see it.

“It’s very rare that it causes symptoms in young children. Again, we really see it during those teenage years. It might be because kids are more focused on sports, or more active at that time,” said Dr. Ryckman.

That’s exactly when both Ryan and Carter noticed problems.

‘Something was wrong. It was hurting.’

Carter, who plays wide-receiver and safety, had a few tell-tale signs that it was time to do something about the concave chest. The then 14-year-old noticed, “it was getting hard to play sports and work out.”

“One day, I was playing catch with my dad outside, and I realized something was wrong. It was hurting. I knew I needed to look more into that,” he said.

“It was tough to hear and see that,” said Kristy Sveeggen, Carter’s mom. “But, we knew we had to do something. He’s such an athletic kid. I thought ‘it’s only going to make him better,'” she said.

Ryan, who’s a quarterback and cornerback, said his case was nearly identical.

“I started noticing it during conditioning. It felt like my chest was burning,” he said.

Nuss procedure

Carter was referred to Dr. Ryckman in 2018, and Ryan in 2019. Dr. Ryckman told them the Nuss procedure would help.

The procedure, he explained, essentially flips the concave chest out.

“We make incisions on both sides of the chest. The operation involves taking a bar, usually made out of stainless steel or titanium, and passing the bar from one side of the chest to the other.

“When we flip the bar over, it pushes the sternum out and instantaneously creates additional chest capacity. It corrects the pectus, flattening the chest out. The bar stays in for about two to three years. The body will remodel over the shape of that bar. Once that happens, the bars can come out in a few years, and then you have a permanent correction,” he said.

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Carter had his bar removed in December of 2020.

His mom Kristy said Dr. Ryckman and his staff made them feel safe and understood throughout the entire journey.

“If I felt uncertain with anything, they were right there to answer my questions. I’d just like to thank them so much for what they do. It’s just amazing. It really has boosted Carter’s confidence,” she said.

Ryan, whose bar will be in for another two years, had his next appointment with Dr. Ryckman at the end of March. If all goes well, he’ll be allowed to return to contact sports in June.

He and his Mom, Shellie, said they felt confident in the procedure. They saw Carter and Kristy go through it, and saw how much they trusted Dr. Ryckman.

Shellie says if any parents have children going through this journey, keep up with medical appointments. Even if you don’t think you need to.

“Because we kept on it, we realized how glad we were that we followed up and kept the appointments. Sometimes you think it’s no big deal, but it is,” she said.

Post procedure

Carter said because of the procedure, he’s noticed an improvement in not only his athletic performance, but also his confidence.

“When I was younger and going swimming, I would always want to wear a swimming shirt. I was afraid what other people would say when they saw my chest. But now, I don’t wear one because it looks normal. I’m really glad I went through it.

“I’d recommend it to anyone. It helps in your performance, and in the long run, you’ll be able to have a healthier life,” he said.

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Posted In Children's, General Surgery, Sioux Falls, Specialty Care