The Polyhedral Matrix Configuration (PMC) Technique: A Retrospective Cohort Study of Geometric Standardization of Acellular Dermal Matrix Wrapping and Operative Efficiency in Prepectoral Breast Reconstruction

<b>Background</b>: Prepectoral breast reconstruction with an acellular dermal matrix (ADM) typically requires intraoperative manual tailoring, introducing structural variability and workflow delays. We developed the Polyhedral Matrix Configuration (PMC) technique-a geometric method for standardizing ADM shell creation-and compared it to our traditional "tear-drop" wrap to determine whether standardization improves structural integrity and operative efficiency. <b>Methods</b>: We reviewed all consecutive 227 patients undergoing immediate prepectoral reconstruction from January 2021 to December 2024 (tear-drop group: n = 155; PMC group: n = 72). PMC transforms planar ADM into a 3D dome using pre-designed wedge resections and butt-joint sutures, eliminating material overlap. Standardization permits back-table fabrication during mastectomy ("parallel two-team workflow"). We excluded bilateral cases for consistent operative time assessment and performed subgroup analysis to control for higher robotic mastectomy rates in the PMC cohort. <b>Results</b>: PMC reduced the plastic surgery time by a mean of 44.6 min (95% CI: 35.2-54.0) (<i>p</i> < 0.001), with subgroup analysis confirming efficiency gains across both conventional (32.8 min, 95% CI: 20.1-45.5, <i>p</i> < 0.001) and robotic mastectomies (60.8 min, 95% CI: 47.3-74.3, <i>p</i> < 0.001). Despite zero-overlap design, PMC showed no increase in major complications (<i>p</i> > 0.99) and lower rates of visible rippling (odds ratio 0.28, 95% CI: 0.08-0.97, <i>p</i> = 0.032). BREAST-Q "Satisfaction with Breasts" scores were higher in the PMC group (mean difference +7.3 points, 95% CI: 3.1-11.5, <i>p</i> = 0.001). <b>Conclusions</b>: Geometric standardization enables both design precision and operative efficiency. By separating reconstruction preparation from mastectomy through a reproducible protocol, PMC reduces the operative time while improving aesthetics through stable, single-layer construction.