With the use of the three-point lap-diagonal seat belt restraint, there has been a reduction in the number of deaths caused by automobile trauma. However, a new pattern of injury has emerged, the 'seat-belt syndrome', which comprises a constellation of injuries including soft tissue injury to the breast. Given that seat belt legislation is becoming more widespread, it is likely that the incidence and reporting of these injuries will become more common. In this paper, we provide an overview of the varied clinical and radiological presentations, and suggested management of seat belt injury to the female breast. The consequences of such injury can be severe in their functional, psychosocial and aesthetic impact, and thus, using an index case as an example, the previously unreported area of breast reconstruction in a breast deformed as a result of blunt trauma is discussed, highlighting some of its challenges.