A 45-year-old patient had routine cosmetic bilateral breast augmentation 6 years previously using cohesive gel implants. She presented 4 years later with a breast lump and multiple axillary lymph nodes. Exploration revealed that the breast implant had a large tear at the posterior wall of the shell with intra-capsular leakage of silicone. The axilla had eight enlarged lymph node--all were removed. Histology showed silicone granuloma in the capsule and silicone lymphadenitis. High cohesive gel implants may not be as safe as is commonly believed and all implant ruptures, irrespective of the cohesiveness of the silicone gel, should be investigated thoroughly.