"Let's look at the left one first," Dr. Terry Dubrow says during Kim's consultation in the clip below. "Thin skin, little bit of rippling and the nipple's going down. The treatment for that is to lower the pocket a little bit -- that'll allow the nipple to come up -- and put a silicon implant in."
Dubrow then examines the right breast, telling Kim, "This one is [capsular contracture] encapsulation, which is very significant. There are four grades: Grade one means soft, essentially no encapsulation. Grade four means super firm, painful and displaced."
"That's me," Kim says.
"You have grade four," Dubrow confirms.
But Durbrow is concerned about Kim's weight, telling the reality star, "You're so thin that despite the encapsulation, you can feel the implant, so if we take the scar tissue out, you're gonna have paper-thin tissue on top of an implant," which Dubrow warns could result in a "ripply" look.
Dubrow's challenge: find the right balance between manipulating Kim's scar tissue to relieve her pain and leaving her enough soft tissue to ensure aesthetically pleasing results. He does warn Kim that "there's no guarantees that [the surgery] is going to work."
"It's very scary when you don't know," Kim says during her confessional. "Will it happen again? Will I be in pain again? But I honestly have such faith in Dr. Dubrow, I feel great about it."