There is a famous Machlokes about the nature of Karies by Mila. the Rambam holds that every day that a Gadol doesn't do Mila he transgresses an Asei. There is no Karies all his life. If at the end of his life he hadn't gotten a Mila, then he gets the Kareis then. The Raavad says that there is a Chiyuv Kareis for each moment that he didn't have Mila, but if he preforms the Mila, then he's done T'shuva for it and doesn't have the Kareis.
The Gemara at the end of Yuma says that for transgressing an Asei all you need is Tshuva and you're forgiven. If you transgressed a Chiyuv Kareis, then you need also Yom Kipper and Yisurin (pain) to achieve atonement. According to the Rambam, when you get the Mila, it turns out that all you transgressed where Asei, therefore you don't need anymore than T'shuva. According to the Ravad you can say that until now he was transgressing a Kareis and therefore T'shuva alone won't help. But the Minchas Chinuch is more inclined to say that since you did the Mila, retroactively the Chiyuv of Kareis comes off. Therefore all you're left is with an Asie, and T'shuva is enough.
If you didn't get a Mila in the beginning of your adult life on purpose. Then, towards the end of your life when you decided that you'll have your Mila, but through an Ones (circumstances that are not in your control) you cannot have a Mila. The Ravad would hold that there is a Chiyuv Kareis, since you transgressed in the beginning and the end is just a make-up for the beginning. If you do the Mila at the end, you canceled out the wrong you did in the beginning. If you never fixed it up, even if it was out of your control, you're still left with not doing Mila in the beginning on purpose. Therefore the person has Karies on him and T'shuva alone won't help.
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