Despite its popularity, the use of silicone breast implants can be associated with many complications and has been the focus of criminal and civil litigations. Major local and perioperative complications include fibrous contractures, rupture (intra- and extracapsular), gel migration, silicone exudation through skin or nipple, infection (operative, peri-implant, intraimplant), hematoma or seroma, foreign-body giant cell reaction, siliconomas, fat necrosis, and peri-implant calcifications. Serious and often fatal complications are reported most commonly with direct tissue injection of large quantities of silicone, a procedure that is largely obsolete today. Large quantities of viscous silicone material are often injected into tissue spaces and then massaged locally. The local build-up of pressure forces the silicone into angiolymphatic channels, with resultant distant migration, akin to “fat embolism.” Involvement of the pulmonary and neurologic systems is the most dreaded complication and often warrants emergency management. Other distant complications encountered with breast implants include lymphadenopathy, granulomatous hepatitis, arthritis, and acute serum sickness-like illness.