Silicone gel from ruptured implants can migrate to locations such as the chest wall, axillae, and upper extremities, resulting in granulomatous inflammation. Pleural silicone granulomas have rarely been reported in the literature. This is a rare case of pleural silicone granuloma, which demonstrates that silicone gel from an extracapsular implant rupture can fistulise into the pleural space along a remote thoracotomy scar.