Silicone lymphadenopathy has been associated with fracture and/or erosive breakdown of silastic implants in joint replacements and is also known to occur with cosmetic and reconstructive breast implant surgery. In the orthopedic literature rare malignant lymphomas have been reported in association with silicone granulomas in lymph nodes; whether silicone is a causative agent remains controversial. We report a single case of a 56-year-old woman who had painful capsular contractures and a 2-cm palpable nodule medial to her silicone mammary implant. Histologically the mass comprised an extra nodal follicular mixed lymphoma with surrounding granulomatous response to polarizable foreign body material. Paraffin immunophenotyping, bcl-2 protein staining, and gene rearrangement analysis verified this diagnosis.