Breast Revision Surgery in Korea: Capsular Contracture, Rupture, Implant Replacement and Removal

Why do people have breast revision surgery?

Breast revision corrects problems from an earlier implant surgery, or removes or replaces the implants. The main reasons are below.

Capsular contracture and the Baker grade

Capsular contracture happens when the membrane the body forms around the implant, which it treats as a foreign object, becomes too thick and shrinks. Severity is described with the Baker grade.

In general, surgery is considered for grades 3–4, and grade 2 is judged by watching for change. The grade cannot be confirmed from photos alone.

Implant rupture and silicone leak: confirmed by imaging

A ruptured saline implant is easy to notice because the breast visibly shrinks. A ruptured silicone gel implant can look unchanged, so some people don't know. That is why imaging is needed.

• Ultrasound: easy to access and often used as the first check. Accuracy depends on the examiner's experience.
• MRI: the most detailed test for rupture, used when ultrasound is unclear or suspicion is high.
• Whether silicone has leaked outside the capsule changes how much needs to be removed.

How malposition, asymmetry and rippling are handled

Implants shift when the pocket was made too wide or too narrow, or when tissue stretches over time. Changing the implant alone will not fix this; the key step is making the pocket smaller or larger.

• Sideways drift / bottoming out: stitch the relevant part of the pocket to reduce it, or reinforce it
• Left-right asymmetry: pocket height and implant size are sometimes designed differently on each side
• Rippling: if skin and fat are thin, add a thicker layer, change the placement plane (over the muscle, under the muscle, dual plane), or cover with fat grafting
• If the breast sags a lot, changing the implant alone won't give a good shape, so a breast lift is considered together

Surgical methods: capsule treatment, endoscope, incision site

Capsule treatment

• Capsulectomy: removing the thickened capsule. It can be partial or total; how far to go depends on the capsule's condition and whether silicone has leaked.
• Capsulotomy: cutting the capsule to release it. It is used for mild cases, but it can recur, so it is chosen depending on your condition.
• En bloc removal, taking the implant and capsule out together, is considered when there is rupture or leakage, or when BIA-ALCL is suspected.

Endoscope and incision site

• Endoscope: working through a small incision while viewing inside helps control bleeding and tidy the pocket, which is useful in revision. Whether it is used depends on the clinic and your condition.
• Reusing the incision: the scar from the first surgery (armpit, areola or breast fold) is often reused. Because revision needs a clear view and pocket work, an incision in the breast fold is sometimes recommended.

Surgery time, anesthesia, drain and compression garment

1. 1
   Day 1 of your stay — consultation and tests: the doctor examines you with your previous surgical records, and you have an ultrasound or MRI and blood tests. Your manager interprets and confirms that the doctor you consult is the one who operates.
2. 2
   Surgery day — come in after fasting, under general anesthesia (check that an anesthesiologist is present). Replacement alone takes 1.5–3 hours; adding capsulectomy, lift or fat grafting can take 3–5 hours.
3. 3
   Days 1–3 — dressing changes and progress checks. If a drain (a tube that removes blood and fluid) was placed, it is usually taken out at this point. You start wearing the compression garment.
4. 4
   Days 7–10 — stitches out, and an ultrasound or similar check of implant position. Swelling and bruising are greatest in the first 1–2 weeks; daily activities settle in about 1 month and the shape in 3–6 months.
5. 5
   Before you fly home — confirm you are cleared to fly and collect your new implant information and surgical record

Length of stay and flying

For revision with implant replacement only, we generally recommend a 7–10 day stay; if you add capsulectomy, a lift or fat grafting, or the drain comes out later, 10–14 days. As a rule, you fly home after the first check (stitch removal and position check).

• Preventing blood clots: long flights after surgery raise the risk of leg clots. Fly only after your doctor clears you, wear compression stockings, walk every 1–2 hours and drink water often.
• Wear your compression garment on the flight as the clinic instructs.
• Don't lift carry-on bags yourself — ask airport staff for help. No heavy lifting for 2–4 weeks.
• Avoid saunas, jjimjilbang, swimming pools, alcohol and smoking for the period the clinic tells you. Finish your sightseeing before surgery.

Confirming genuine implants and getting your records

At a revision, the record of your new implants becomes the reference for future surgery and checkups. Be sure to get the following.

• Product name, manufacturer, size (volume), shape and surface type
• Serial number and lot number (the unique numbers on each implant)
• Warranty card and patient implant card
• Opening check in the operating room: ask that the implant package be opened just before surgery so the product information and numbers can be verified
• Operative record (type of surgery, incision site, placement plane, capsule treatment, whether a drain was used)

What to prepare before your consultation

• Your previous surgical records and discharge papers, and your implant card (product name, numbers, size)
• Recent ultrasound or MRI results (images and the report)
• Where, in which country and when you had the surgery, and any symptoms since (pain, firmness, shape change, warmth)
• Medications you take and any allergies
• Front, side and 45-degree photos, and reference photos of the shape you want
• If you have no records, ask the clinic where you had surgery, or have a Korean clinic check the current implant condition with imaging

Checkups after you return home, and BIA-ALCL

BIA-ALCL is a rare lymphoma that develops around implants and has mainly been reported with textured (rough-surface) implants. The FDA and Korea's MFDS have issued guidance, and it is generally known to be treatable by removing the implant and capsule when found early. Know your current implant's surface type, and get checked right away if you have symptoms.

• 1, 3 and 6 months after surgery: share photos with the clinic to track your progress
• After that, follow the FDA recommendation: a first imaging check at 5–6 years, then an ultrasound or MRI every 2–3 years (follow the clinic's instructions if they differ)
• Bring a copy of your implant card so the product name and numbers appear on the imaging request
• Contact the clinic immediately if one breast swells, suddenly hardens or you have a fever
• Keep up regular breast cancer screening, and tell staff about your implants before any test

Questions to ask at your consultation

1. What is the problem with my implants, and which test shows it?
2. How much of the capsule will be treated? Do I need en bloc removal?
3. Is placing new implants right for me, or would removal or fat grafting be better?
4. Will you reuse my previous scar? Will you use an endoscope?
5. Please tell me the placement plane and the new implant's product, surface and size.
6. Is the person who operates the same doctor I consulted? Is an anesthesiologist present?
7. How many days will the drain stay in, and how long do I wear the compression garment?
8. On which day can I fly?
9. Can I get the genuine-product documents (serial, lot, warranty) and my surgical record?
10. If I'm not satisfied, what are the criteria for a re-operation and how do I contact you?

How to choose a clinic

• Check that the clinic regularly handles breast revision and implant removal — see if they are listed as official services.
• Whether they examine you with your previous surgical records and imaging results, and don't decide from photos alone
• Whether an anesthesiologist is present for general anesthesia
• Whether they have an endoscope and imaging equipment (ultrasound)
• Whether there is photo consultation or a contact channel if a problem arises after you go home

KBEAU connects you with partner clinics in Seoul's Gangnam area that handle breast revision. Send us your previous surgical records and current photos and we will tell you in advance the likely surgical approach and number of days you need, and a manager accompanies you to interpret at the consultation, surgery and follow-up check. We can also arrange accommodation near the clinic and an airport pickup car.