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Liquid silicone injections for breast augmentation are associated with significant complications. They remain prevalent in transgender and gender-diverse populations facing barriers to regulated surgical care. We present a case of a transgender female with a history of breast silicone injections who developed local complications requiring surgical excision. Clinical breast images and gross pathology are provided. This case highlights characteristic clinical features of silicone-related complications, the role of imaging in diagnosis and the importance of equitable access to safe gender-affirming care.