This case describes a unique complication of silicone breast implantation that is previously undocumented. Internal mammary silicone lymphadenopathy mimicking breast cancer recurrence represents an important new clinical entity. The diagnosis and management of this clinical enigma are challenging. In our patient, videothoracoscopy proved to be minimally invasive and allowed complete resection of the entire chain of pathologic nodes. Explantation of the silicone prostheses and complete capsulectomy are indicated. Light microscopy alone can suggest the diagnosis of silicone lymphadenopathy. Infrared spectral analysis can be a helpful adjunct to allow an unequivocal diagnosis.