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

Background: 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. Methods: 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. Results: PMC reduced the plastic surgery time by a mean of 44.6 min (95% CI: 35.2–54.0) (p < 0.001), with subgroup analysis confirming efficiency gains across both conventional (32.8 min, 95% CI: 20.1–45.5, p < 0.001) and robotic mastectomies (60.8 min, 95% CI: 47.3–74.3, p < 0.001). Despite zero-overlap design, PMC showed no increase in major complications (p > 0.99) and lower rates of visible rippling (odds ratio 0.28, 95% CI: 0.08–0.97, p = 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, p = 0.001). Conclusions: 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.