Breast Filler and Injected Material Removal in Seoul: When to Remove It, Breast Screening and How the Space Is Restored

What is the first thing to work out: an implant, or injected material?

The first thing to establish is what is actually in the breast. A silicone implant is a pouch with a shell around its contents, so it can be removed or exchanged as one piece. Injected material has no shell. It spreads directly between fat, the glandular tissue (the tissue that makes milk) and muscle. Over time the body often wraps it in a hardened layer of scar-like tissue, called a capsule. Both may be called "breast foreign material", but they are removed differently and leave different results.

Replay

1. 1Implanta pouch of filling inside an outer shell · can be removed or exchanged whole
2. 2Injected materialno shell, so it seeps directly between fat, gland and muscle
3. 3Over timesurrounding tissue may wrap the material in a hard capsule

What has been injected into breasts has changed over the decades. Paraffin was used in the early twentieth century and liquid silicone later. From the late 1980s, polyacrylamide hydrogel (a gel that holds a lot of water) was used widely in Ukraine, Russia and China.¹ Today people also come with problems after hydrogel fillers such as Aquafilling or hyaluronic acid injected into the breasts, and many were injected abroad and do not know the product. A Japanese study, from a country where silicone and paraffin injections are banned, noted that some patients injected overseas or injected several times did not know what they had received.⁵

What is in the breast?

• 1Injected material only

  Removal and filling of the space are planned together

  The case covered in this guide

• 2A silicone implant only

  Implant exchange or removal is considered

  See revision breast surgery

• 3Injected material plus an implant

  Each is mapped on imaging, then the order of treatment is set

  Plan the order first

• 4Not sure what it is

  Ultrasound or MRI comes first, along with old records and what you were told

  Imaging first

Implant exchange or removal, and filling with your own tissue after implant removal, are covered on our Revision Breast Surgery page. This guide focuses on injected fillers and foreign material.

What problems can injected material cause?

Each material shows itself at a different time and in a different way.

• Paraffin: it often looked acceptable at first, but records describe hard knots and draining tracts (fistulae, small channels that leak pus) appearing five or ten years later.¹
• Liquid silicone: the average time from injection to complications is about nine years. Painful lumps appear within two or three years in some women, and only after ten or fifteen years in others.¹

When silicone works its way into the skin, circulation in the skin can get worse in stages. It starts with fine visible capillaries and, at worst, ends in skin necrosis (skin tissue dying). In one reported case, much of the silicone injected into the breasts had moved down to the abdomen over thirty years.¹

With polyacrylamide hydrogel, migration, lumps, pain, infection, firmness and disfigurement have appeared from a few months to three years after injection. Leakage of the gel back along the needle track is thought to be one cause of migration.¹ In China, 161 of 183 adverse event reports received between 2002 and November 2005 involved breast injections, and the production, sale and use of the material were then banned.¹ A study of 135 women who had this gel removed reported these problems: hard lumps and nodules (60.0%), pain (27.4%), anxiety (22.2%) and migration (13.3%). Others were asymmetry (8.1%), swelling (5.9%), infection (5.2%) and calcification (3.7%).² Put simply, about six in ten of the women who had it removed had firm lumps.

Even hyaluronic acid, which the body can break down, frequently forms multiple encapsulated lumps when injected into the breasts. Once encapsulated, these lumps often do not dissolve with enzyme injections and have had to be removed surgically.⁵

If you noticeFirst consider

A firm lump that hurts when pressedCollected material, a hard capsule

One side larger or changing shapeMigration or pooling of material

Red, hot swelling with feverInfection: treat this first

Thin skin with visible capillariesMaterial reaching the skin layer

Lumps below the breast or on the abdomenMaterial that has moved downward

A screening report that is hard to readMaterial can hide other changes

How does injected material affect breast screening?

Screening matters as much as shape. In the 135-patient hydrogel study, breast cancer was found in 4 women (3.0%). The authors stressed that, although rare, it can be hidden by the gel and the tissue around it.² In another series, two candidates whose pre-operative tests strongly suggested cancer were referred for diagnosis and excluded from fat grafting.⁴

On mammography (a breast X-ray), a silicone-injected breast may show many round masses of 0.2 to 2.0 cm, often calcified, or broad white areas when large volumes were used.¹ In other words, the material can block the view of what lies behind it. A radiology review therefore notes that mammography remains the screening test, but that breast MRI without contrast dye is a useful extra test for women with injected material. MRI with contrast dye (a medicine that makes images clearer) is needed when infection or cancer is suspected.⁶ That is why you should always tell the screening center what was injected and when.

Which layers of the breast does the material occupy?

Beneath the skin of the breast lie the fat layer, the glandular tissue, a thin space behind the gland, and the large chest muscle (pectoralis major). Injected material rarely stays in one layer. In one reported case, MRI showed it both behind the gland and beneath the muscle.¹ When the area is refilled after removal, fat has been placed in several layers around the cavity rather than into the empty space itself.⁴

Replay

1. 1Fat under the skinjust below the skin · tends to scatter as small deposits
2. 2Glandular tissueseeps between the milk-making tissue · easily left behind
3. 3Behind the glandthe thin space between gland and muscle · may pool in a pocket
4. 4Pectoralis majorinto or under the muscle · often in more than one layer

Which layer the material occupies changes both the method and the chance that some is left. A study of 436 breasts that had hydrogel removed linked four things to more complications after surgery:

• Gel that had soaked into the glandular tissue on MRI
• A longer time since injection
• Previous needle aspiration (drawing material out with a syringe)
• A hardened capsule³

How is it removed, and how far can removal go?

The usual method depends on the state of the material.

A cannula is a thin tube with a blunt tip, and the areola is the darker skin around the nipple. Hydrogel comes out much more completely from a large pocket than from many small scattered sites.¹ Even so, in the 135-patient study, gel was left behind after removal in 17.0% and loose skin was seen in 7.4%.² The breast becomes smaller in proportion to what is removed, and skin that has been stretched for years may look loose.

Replay

1. 1A large poolopened and squeezed or washed out, or suctioned with a cannula · a single pocket comes out more easily
2. 2The hard capsule tooremoved along with the material · if it stays, the space does not close well
3. 3Scattered and seeped materialeasily left behind · material remained in 17.0% in a 135-case study
4. 4Smaller by what came outthe breast gets smaller and long-stretched skin may look loose · 7.4%
5. 5When fillingfat is placed in several layers around the space, not into the space itself

When, and with what, is the space restored?

Leaving the breast unfilled lowers the chance of further surgery, but can lower satisfaction. A 20-year comparison of 436 breasts found:

• Complications after surgery: 50.0% with same-day reconstruction, 31.3% with delayed reconstruction and 26.7% with no reconstruction
• Reoperation: 26.2%, 18.8% and 13.0% in the same order
• Satisfaction: the no-reconstruction group scored lower for satisfaction with the breasts and for psychosocial and sexual well-being than either reconstruction group.³

The authors concluded that delayed reconstruction is a safe and effective option.³ Delayed filling had fewer complications than same-day filling, and higher satisfaction than no filling.

Replay

1. 1Complications after surgerysame day 50.0% · later 31.3% · no reconstruction 26.7%
2. 2Reoperationsame day 26.2% · later 18.8% · no reconstruction 13.0%
3. 3Satisfactionwithout reconstruction, breast, psychological and sexual satisfaction scores were lower
4. 4The authors' conclusiondelayed reconstruction was judged a safe and effective option

A series of 162 women who had fat grafted on the same day as removal recovered without severe complications. But it excluded anyone with infection or skin ulceration (an open sore) from the start, and stated that fat grafting should wait until any infection is fully controlled. Fat was placed over an average of 1.6 sessions (range 1 to 3).⁴ So whether same-day filling is possible depends on the absence of inflammation and on the condition of the tissue.

How we approach it at Bonita Clinic

At Bonita Clinic, we perform breast foreign material removal as surgery under general anesthesia or sedation, with same-day discharge or a one-night stay, and stitches.

Treatment options you can discuss in Seoul

Bonita Clinic has worked from the same place since 1995, and Dr. Kwang-Seop Chung, a board-certified plastic surgeon (Brazil), sees each patient in person. For injected breast material, consultation covers:

• Ultrasound to locate the remaining material, its size and the state of the tissue
• Surgical removal by hand or fine cannula, freeing adhesions while limiting damage
• Fat grafting with your own fat to fill the space, timed to the tissue's condition
• Combined laser treatment for marks and skin texture, and follow-up of scars at our Scar Clinic
• Separate planning through our revision breast surgery service if an implant is also present

Breast MRI, mammography and other screening tests mentioned here are general medical information. Bring any reports you have; whether further imaging is needed is discussed after the examination.

Why do the plan and cost differ from person to person?

The name of the problem says little about the operation. The amount of work does.

• How much was injected, and into which layers
• Whether a hardened capsule must come out too
• Fat grafting the same day, later, or not at all
• General anesthesia or sedation, overnight stay
• An implant that also needs attention
• Infection or skin damage to settle first

Final plan and quote after an in-person exam and ultrasound

The final estimate is given only after the in-person examination, once the layers involved, the need for capsule removal and the restoration plan are clear.

What can photos show, and what needs an in-person exam?

Photos show the outside of the problem. The decisions depend on what lies beneath.

Photos can show

• Size difference and shape changes
• Visible lumps or bulges
• Skin color, thinning or capillaries
• How the shape changed (older photos)

Needs an in-person exam

• Which layers hold the material
• Whether gel has entered the gland
• Capsule hardness and adhesion
• Active infection
• How much fat is available to graft

Helpful photos: front, both sides at 45 degrees and side views, arms relaxed and then raised, in good light, without your face. Photos from before the first injection help us understand your original shape. Please also keep any mammography, ultrasound or MRI reports ready. You can message us the photos together with whatever you recall about the injections and any screening results.

Planning your stay and recovery

The confirmed details are those above: surgery under general anesthesia or sedation, same-day discharge or one night in the clinic, and stitches. How long to stay in Seoul, how many follow-up visits you need and when stitches come out all vary. They depend on how much is removed and whether fat is grafted at the same time. These are planned with you at consultation.

Recovery after breast material removal usually goes like this:

1. After surgery: swelling and bruising are managed with compression and cold packs.
2. As the swelling settles: the contour of the breast becomes clearer.
3. Settling: touch-ups are judged only after the removal and grafted areas have stabilized.

After you return home, seek care promptly if redness, heat, pain, fever or discharge increases. For future screening, tell the radiologist that material was injected and later removed, and whether any may remain; bringing the operation summary helps them read your images.

Real treatment cases

These cases appear on Bonita Clinic's breast revision page. Results vary from person to person, and both show how volume decreases in proportion to what is removed.

Both breasts rounded and full up to the upper pole

Both breasts enlarged, with a difference in shape between sides

* Results vary from person to person. Side effects are possible, so please decide after a thorough consultation with a doctor.

Frequently asked questions

I have no symptoms right now. Should it still come out?

Whether surgery is needed now varies from person to person. Injected material can make breast screening harder, so a screening plan should be agreed in advance.⁶ If lumps, pain or a change in shape appear, it is better not to wait. We look at the current state with ultrasound and decide together.

How much smaller will my breasts be after removal?

It depends on how much was injected and how much glandular tissue you have. Removing the material together with the hardened capsule reduces volume accordingly, and skin that was stretched may look loose. That is why removal and restoration are planned together.

Can fat be grafted on the same day as removal?

Sometimes, but conditions apply. The same-day series excluded patients with infection or skin ulceration,⁴ and another study found more complications with same-day reconstruction than with delayed reconstruction.³ Timing depends on whether inflammation has settled and whether gel has entered the glandular tissue.

Will it affect breastfeeding or future screening?

Injected hydrogel itself has been reported to cause breastfeeding difficulties.⁴ The effect of removal also depends on how much the surgery involves the gland, so tell us if you plan a pregnancy. For screening, sharing both your injection history and your removal history helps the radiologist.⁶

Where will the scars be?

Along the incisions, for example at the edge of the areola or in the fold under the breast.⁵ Silicone or paraffin tangled in the gland may need larger incisions.⁵ We keep incisions as small as possible and place them where they show least, and remaining scars are followed up at our Scar Clinic.

Before your consultation

• When, where (including which country), how many times and roughly how much was injected on each side, and any product name you were told
• Whether material or pus was ever drawn out with a needle; previous aspiration has been linked to later complications³
• Dates and reports of mammography, ultrasound or MRI
• Any breast implant surgery or fat grafting in the past
• Pregnancy or breastfeeding plans, and any family history of breast cancer

Bonita Clinic is on the 3rd floor of 565 Gangnam-daero, Seocho-gu, Seoul, about 100 m on foot from Exit 8 of Nonhyeon Station (Line 7). Read more on our Breast Surgery Revision page. For implant exchange or removal see Revision Breast Surgery. For material injected into the buttocks, hips or legs see Buttock & Leg Surgery Revision and the guide to buttock and leg filler removal.