ABOUT THE PROVIDER: Joe Doe STATE: Colorado ABOUT THE PATIENT: Type of AFC Surgery: Mastectomy AFC Bra cup size: D-F cup Age: 56-75 yrs Race: Native Hawaiian or Other Pacific Islander Body type: Overweight (BMI 25.0 – 29.9) Incision pattern: Wise Pattern Surgical Specifications: Tissue rearrangement with de-epithelialization BEFORE SURGERY: AFTER SURGERY: