Clinical outcomes of mastectomy in frail or systemically untreated T4 breast cancer patients: a single-center real-world study

Abstract

Aims: The optimal management of frail patients with T4 breast cancer who are unable to tolerate standard systemic therapy remains unclear. This study aimed to evaluate the outcomes of mastectomy in frail patients with T4 breast cancer who were unable to receive systemic therapy using real-world data.Methods: This retrospective analysis of institutional records included 27 patients who underwent mastectomy for clinical T4 breast cancer at the surgical oncology department of a tertiary referral center between October 2022 and December 2025. Patients who could not receive systemic therapy because of advanced age and/or significant comorbidities, or who developed uncontrollable local complications during neoadjuvant therapy, were included. Clinicopathological characteristics, postoperative complications, reoperations, local recurrence, and overall survival (OS) were retrospectively evaluated. OS was analyzed using the Kaplan-Meier method.Results: The mean age was 69.6±15.9 years (median, 74 years). Surgery was performed because systemic therapy was not tolerated in 66.7% of patients, whereas 33.3% underwent surgery for local complications developing during neoadjuvant therapy. The overall postoperative complication rate was 44.4%, most commonly seroma (14.8%), surgical site infection (11.1%), and major wound dehiscence (11.1%). Reoperation was required in three patients (11.1%). Negative surgical margins were achieved in 74.1% of cases, local recurrence occurred in 11.1%, and median OS was 20.0 months (95% CI, 14.3-25.7 months).Conclusion: Mastectomy is an effective option for local control and palliation in selected frail patients with T4 breast cancer. Although postoperative complications are relatively common, most can be managed conservatively, and local recurrence rates remain low.