Fanny Burney’s mastectomy: tuberculosis not carcinoma

Abstract

Breast cancer has been a companion to humankind since prehistory. From our present-day perspective, the complete surgical removal of a breast tumour represents the most effective therapy when combined with anaesthesia and antisepsis. Here we report on the earliest description of a pre-anaesthetic mastectomy by a patient namely Frances (Fanny) Burney (1752-1840) with an independent description from the surgical team. The operation was performed under the direction of Baron Antoine Dubois (1756-1837) head of maternity services to the Emperor Napoleon (1769-1821). The surgeon, Baron Dominique Jean Larrey (1766-1842), was Surgeon-in-Chief of Napoleon’s armies. Although the operation took 20 minutes to perform, the recovery from the operation, both physical and psychological, took several years. We performed differential diagnosis of Fanny Burney’s breast disease. We propose that her supposed breast tumour was not a breast carcinoma, but a sclerosing tuberculous mastitis. As a matter of fact, Fanny Burney survived 29 years after the surgery without any recurrence and died aged 87 years old. Beyond this, the meticulous description of mastectomy without anaesthesia remains one of the most impressive reports of this treatment in history. Fanny Burney’s story illustrates the power of contemporaneous documents in providing evidence to conclude her probable disease pathology, without the presence of the diseased tissue for analysis.