Objective: This study aimed to characterize the spatial distribution of CD8A⁺PD-1⁺TIGIT⁺ exhausted T cells in HER2-positive breast cancer and to investigate their spatial relationship with CD44⁺CD24⁻ breast cancer stem cells. Method: Formalin-fixed paraffin-embedded HER2-positive breast cancer specimens were analyzed using multiplex immunofluorescence, pathological region annotation, and spatial proteomic analysis. Regions of interest were annotated based on histological features, including invasive carcinoma-associated areas, adjacent stroma, peritumoral fibrous tissue, and adipose tissue. CD8A⁺PD-1⁺TIGIT⁺ T cells were identified at the single-cell level, and their regional distribution was quantitatively compared. Spatial mapping, distance-based analysis, and interaction network analysis were performed to evaluate the spatial association between exhausted T cells and CD44⁺CD24⁻ BCSCs. Pairwise comparisons were conducted using two-tailed Welch’s t-test. Result: CD8A⁺PD-1⁺TIGIT⁺ T cells were preferentially enriched in invasive carcinoma-associated regions and adjacent stromal areas, with significantly lower abundance in peritumoral fibrous and adipose tissues. Within the CD8A⁺ T-cell compartment, the proportion of triple-positive exhausted T cells was highest in invasive lesions and decreased toward peripheral non-invasive regions. Spatial analyses showed that CD8A⁺PD-1⁺TIGIT⁺ T cells and CD44⁺CD24⁻ BCSCs were co-enriched in invasive carcinoma, tumor–stromal interface zones, and lymphoid tissue-associated microregions. Distance-based heatmaps and interaction network analyses further confirmed recurrent spatial proximity between these two cell populations. Conclusion: CD8A⁺PD-1⁺TIGIT⁺ exhausted T cells are spatially enriched in invasive pathological microregions of HER2-positive breast cancer and show close spatial association with CD44⁺CD24⁻ BCSCs. The observed spatial overlap between tumor stemness and T-cell exhaustion defines a localized suppressive niche. This interplay likely underpins the biological mechanisms through which HER2-positive breast cancer evades immune surveillance and develops resistance to therapy.