Bilateral mammary fibrosis in systemic sclerosis: a rare case presentation and comprehensive review of breast involvement in scleroderma

Systemic sclerosis (SSc) is associated with a modestly increased risk of breast cancer, but bilateral benign breast involvement is exceptionally rare. We report severe bilateral breast fibrosis and ulceration in a 60-year-old woman with a 31-year history of limited cutaneous SSc. The patient presented with progressive breast hardening and ulceration over 8 years. Physical examination revealed firm, indurated breasts with taut skin and multiple ulcerations. Imaging studies and biopsies confirmed extensive fibrosis without malignancy. Conservative management with wound care, compression garments, and immunosuppression yielded minimal improvement after 3 months, necessitating bilateral mastectomy. This case highlights diagnostic challenges in differentiating benign fibrotic changes from inflammatory breast cancer in SSc patients and parallels with digital ulcer management. Our literature review reveals the complex relationship between SSc and breast pathology. This report emphasizes the importance of increased awareness among clinicians regarding this rare manifestation requiring individualized therapeutic approaches.