The chapter discusses the clinical and surgical challenges posed by siliconomas—granulomatous reactions resulting from silicone injections or implant ruptures—in the breast. It highlights the complications associated with these reactions, including inflammation, fibrosis, and difficulty in radiological interpretation, which can obscure breast cancer diagnosis, and emphasizes the importance of patient history, physical examination, and advanced imaging techniques to identify siliconomas accurately. The chapter also outlines treatment strategies, which often require surgical excision due to chronic inflammation and esthetic deformity. Furthermore, the author warns about the long-term consequences of silicone use and urges caution with injectable materials in esthetic breast procedures. The text underscores the critical need for multidisciplinary management and patient education, as these cases frequently involve complex reconstructions and may mask or coexist with malignancies.