Radiation-induced morphea (RIM) is a rare, potentially debilitating complication of breast radiotherapy, characterized by localized dermal fibrosis that may extend beyond irradiated fields. It typically arises within 3–12 months after radiation exposure, but can appear years after treatment completion. Aromatase inhibitors (AIs) are frequently prescribed in postmenopausal breast cancer survivors. These agents significantly reduce estrogen levels and may amplify profibrotic pathways, potentially contributing to RIM development. This review examines the relationship between the use of AIs and RIM development, focusing on the clinical presentation, diagnostic challenges, treatment options, and knowledge gaps. RIM can mimic many dermatologic disorders, causing it to be often misdiagnosed as cellulitis, mastitis, post-radiation fibrosis, or recurrent cancer. Misdiagnosis delays initiation of treatment and can lead to poor outcomes, including breast induration, chronic pain, and disfigurement. A skin biopsy is needed for diagnostic confirmation. There are several reported treatment options for RIM, including topical or systemic corticosteroids, mesalazine, phototherapy, and many others. Current treatments provide predominantly symptomatic relief, and there is no standardized treatment at this time. As this condition can appear several years after radiation, it is recommended that breast cancer patients, especially those who currently or previously received AIs, receive periodic skin examinations after completing radiation. Incorporating dermatologic exams into long-term care allows for close monitoring of irradiated skin, facilitating earlier recognition of cutaneous changes and timely management.