Submit to Gallery

Contribute to the AFC Gallery!

This database will serve several critical functions in improving the standard of patient care in this setting. It will facilitate clear communication between patient and provider & help to set expectations; it will allow patients facing surgery to visualize what they might look like should they choose the AFC option; and it will provide critical data for future AFC research and training.

Download the sample patient photo release form:  (PDF)   (Word)

Please provide as much information as possible, and contact us if you have any questions about this project.

About the Provider

Provider Name*
Email*

About the Patient

Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB.
Type of AFC Surgery*
Surgical Specifications
Please select all that apply.
(Optional) In many cases, a hybrid surgical approach may be necessary to individualize and optimize the outcome. Please use this space to describe your surgical approach.
Incision Pattern
Incisions*

Patient Breast Cup
Age of Patient*
Patient Race*
Race categories taken from US OMB.
Patient BMI*
Consent*