Delayed hematoma associated with breast implants, whether for reconstructive or aesthetic purposes, is a rare entity. Most reported cases have been intracapsular. Although several mechanisms for delayed hematoma have been proposed, its exact etiology and mechanism of formation are not yet fully understood. The authors present a unique case of hematoma formation 5 years after breast reconstruction with a textured anatomic cohesive gel breast implant. The patient experienced severe thrombocytopenia secondary to chemotherapy, which most probably was the triggering etiologic factor. The hematoma was both intra- and extracapsular. The authors speculate that the retrocapsular hematoma component was due to firm adhesion of the textured prosthetic membrane to the posterior capsule and propose that for breast reconstruction with prosthetic implants in patients likely to receive chemotherapy, a smooth implant might be better indicated.