Silicone leakage from silicone breast prostheses with or without rupture of the prostheses is of great concern. Silicone injection for breast augmentation is still common in Asia, even though silicone injection induced granulomas and associated malignancy have been reported. A series of 24 women who had bilateral silicone injection granulomas in their breasts, requiring subcutaneous mastectomies and immediate breast reconstruction, is presented. Most of the patients had had one silicone injection into each breast. The patients' average age was 37.5 years and removal of the granulomas was done 3-20 years (mean 8.4 years) after the silicone injections. All patients had breast lumps and some had mastitis (21%) and dermatitis (16%) but none had palpable axillary lymph nodes. Mammograms showed diffuse, multiple granulomas of various sizes. Subcutaneous mastectomies were done via inframammary incisions. Immediate breast reconstruction was carried out with double-lumen silicone/saline implants or textured saline-filled implants inserted subpectorally via a separate axillary incision. The implants were entirely covered by the pectoralis major muscle and partially dissected serratus anterior fascia. Two cases had wound infections (8%) as early complications, and two cases developed hypertrophic scars (8%). At 6-41 months follow-up (mean 21.4 months), 69% of the patients had Baker II and 31% of the patients had Baker III breast capsular contractures.