Municipal solid waste incineration bottom ash (MSWIBA) represents both a resource opportunity and an environmental challenge in waste-to-energy systems. This comprehensive review examines MSWIBA’s physicochemical properties, heavy metal behavior, and applications in construction materials, alongside metal recovery techniques and risk mitigation strategies. The research introduces an integrated management framework combining property assessment with coordinated stream processing to reconcile resource recovery with environmental safety. Future studies should focus on advanced analytical methods, hybrid processes, long-term immobilization mechanisms, and life cycle assessment. These innovations aim to transform MSWIBA into a sustainable resource, supporting circular economy principles and low-carbon development.