Skin-Sparing Mastectomy with Immediate Reconstruction in the Treatment of Breast Cancer with Skin Edema (cT4b)

Purpose: To improve quality of life by de-escalating surgical treatment in patients with breast cancer presenting with skin edema (cT4b). Materials and Methods. This prospective study included 55 patients with stage cT4bN0–3M0 breast cancer. Prior to neoadjuvant systemic therapy (NAST), all patients underwent breast skin biopsy in the areolar region and over the tumor projection to exclude the presence of tumor emboli. Patients were stratified into three groups: Group 1 (n = 7), no tumor emboli detected and treated with skin-sparing mastectomy and immediate expander reconstruction, Group 2 (n = 27), no emboli detected and treated with mastectomy without reconstruction, Group 3 (n = 21), tumor emboli detected and treated with mastectomy. Comparative analysis across groups included histological and molecular subtype, tumor grade, tumor size before and after NAST, skin thickness before and after NAST, clinical response per RECIST 1.1, and time to surgery. Outcomes assessed comprised the frequency of tumor emboli in the skin, tumor response dynamics, feasibility of skin-sparing mastectomy with immediate reconstruction, and postoperative quality of life. Results. Complete clinical response in the breast was observed in 71.4% of Group 1, 44.4% of Group 2, and 42.9% of Group 3. Partial response rates were 28.6%, 55.6%, and 47.6%, respectively. Absence of response to NAST was noted only in Group 3 (9.5%). Tumor emboli were concurrently present in both the areola and the skin overlying the tumor in 71.4% of cases. Median time to surgery was 32.7 days (Group 1), 34.6 days (Group 2), and 35.2 days (Group 3). Conclusion. The absence of locoregional metastasis in Group 1 supports the feasibility of skin-sparing mastectomy with immediate expander reconstruction for selected patients who meet the following criteria: no tumor emboli on skin biopsy, resolution of skin edema, and a measurable response to NAST.