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Introduction: Peri‐implant breast seroma is a late clinical presentation of reconstructive surgery or augmentation mammoplasty with breast implants. Pre‐operative cytological evaluation of the peri‐implant breast seroma is a common clinical approach, showing mainly an inflammatory reaction or more rarely a breast implant‐associated anaplastic large cell lymphoma. Herein, we reported the role of cytology in the evaluation of peri‐implant breast seroma and its critical pre‐operative implications. Methods: Eight cases of peri‐implant breast seroma from files at Luigi Vanvitelli University were identified between January and December 2017. In all cases, seroma was aspirated; cytospins were performed and stained by Papanicolaou stain; finally, in all cases, a cell block was obtained for immunocytochemical evaluation and, in one case, for FISH to detect ALK1‐gene translocation. Results: The median age of patients was 48 years and the mean time between the implant placement and the occurrence of peri‐implant breast seroma was 18 months. Microscopic examination showed breast implant‐associated anaplastic large cell lymphoma in one case, aspecific inflammatory reaction in six cases and silicon‐associated reaction in one case. Conclusions: Peri‐implant breast seroma may be caused by several pathological conditions with different clinical behaviour. A proper cytological approach to peri‐implant breast seroma allows a correct differential diagnosis between inflammatory conditions and breast implant‐associated anaplastic large cell lymphoma and an appropriate management of the patient. [ABSTRACT FROM AUTHOR]