Adipose tissue-derived stem cells (ADSCs) represent a subset of the mesenchymal stem cells in every adipose compartment throughout the body. ADSCs can differentiate into various cell types, including chondrocytes, osteocytes, myocytes, and adipocytes. Moreover, they exhibit a notable potential to differentiate in vitro into cells from other germinal lineages, including endothelial cells and neurons. ADSCs have a wide range of clinical applications, from breast surgery to chronic wounds. Furthermore, they are a promising cell population for future tissue-engineering uses. Accumulating evidence indicates a decreased proliferation and differentiation potential of ADSCs with an increasing age, increasing body mass index, diabetes mellitus, metabolic syndrome, or exposure to radiotherapy. Therefore, the recent literature thoroughly investigates this cell population’s senescence mechanisms and how they can hinder its possible therapeutic applications. This review will discuss the biological mechanisms and the physio-pathological causes behind ADSC senescence and how they can impact cellular functionality. Moreover, we will examine the possible strategies to invert these processes, re-establishing the full regenerative potential of this progenitor population.

Mastopexy, with or without implants, is a common cosmetic breast surgery. Despite various techniques, long-term issues like pseudoptosis and recurrent ptosis remain challenging, especially in patients with poor skin quality or significant weight loss. While autologous methods provide stability, they often fall short in complex cases. Therefore, non-autologous reinforcement, such as acellular dermal matrices (ADMs) and synthetic meshes, are increasingly used. This systematic review critically evaluates the efficacy, safety, and outcomes of P4HB mesh in aesthetic breast surgery, focusing on postoperative complications and patient satisfaction. This study followed Cochrane Handbook principles and PRISMA guidelines, with the protocol registered on PROSPERO (ID: CRD42024506060). Analyzing 183 patients (366 breasts) across seven studies, high heterogeneity, the absence of a control group, and a significant risk of bias precluded the possibility of conducting a meta-analysis, resulting in a systematic review instead. This review evaluated the use of P4HB scaffolds in various breast surgeries, including mastopexy, augmentation, and revision procedures. Findings demonstrated improvements in breast support and lower pole stability over time. Complications were minimal. However, the studies highlighted outcome variability and the need for standardized assessment tools to measure results. The P4HB mesh offers notable advantages, including high biocompatibility, long resorption time, and cost-effectiveness, making it a promising option for challenging cases in aesthetic breast surgery. It provides internal support for soft tissues and implants, especially where implant visibility is a concern. However, due to the variability in surgical procedures and the lack of robust evidence, solid conclusions about the optimal clinical use of P4HB meshes are still premature, necessitating further high-quality studies.

Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), is increasingly transforming the study, manufacturing, and clinical translation of adipose-derived stem/stromal cells (ADSCs). ADSC-based therapies face persistent challenges related to donor variability, heterogeneous cell populations, limited standardization of culture protocols, and the need for robust quality control (QC) and potency assessment under Good Manufacturing Practice (GMP) conditions. This review discusses how AI-driven approaches can support the ADSC pipeline from donor and tissue pre-screening, through isolation and expansion, to differentiation and batch release decisions. We highlight major methodological advances in computer vision and label-free imaging for monitoring morphology, confluency, proliferation, senescence, and contamination, as well as AI-assisted optimization strategies for culture parameters and differentiation protocols. In addition, we examine the growing role of multi-omics integration (transcriptomics, proteomics, metabolomics, and secretomics) combined with ML to predict functional potency, stratify donors, and identify biomarkers associated with therapeutic efficacy. Finally, we address current limitations, including data scarcity, inter-laboratory variability, model interpretability, and regulatory requirements, and outline future perspectives such as closed-loop bioprocess control, foundation models, and federated learning frameworks. Overall, AI offers a powerful toolkit to improve the reproducibility, safety, and scalability of ADSC manufacturing and to accelerate the development of standardized, data-driven regenerative medicine products.

Adipose tissue-derived stem cells (ADSCs) represent a subset of mesenchymal stem cells in every adipose compartment throughout the body. ADSCs can differentiate into various cell types, including chondrocytes, osteocytes, myocytes, and adipocytes. Moreover, they exhibit a notable potential to differentiate in vitro into cells from other germinal lineages, including endothelial cells and neurons. ADSCs have a wide range of clinical applications, from breast surgery to chronic wounds. Furthermore, they are a promising cell population for future tissue-engineering uses. Accumulating evidence indicates decreased proliferation and differentiation potential of ADSCs with increasing age, body mass index, diabetes mellitus, metabolic syndrome, or exposure to radiotherapy. Therefore, recent literature thoroughly investigates this cell population's senescence mechanisms and how they can hinder their possible therapeutic applications. This review will discuss the biological mechanisms and the physio-pathological causes behind ADSC senescence and how they can impact cellular functionality. Moreover, we will examine the possible strategies to invert these processes, re-establishing the full regenerative potential of this progenitor population.

Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vasculopathy and tissue fibrosis affecting the skin and internal organs. Genetic and environmental factors influence susceptibility, severity, and onset. Current treatments are limited and not always effective, leading researchers to investigate new approaches, such as the use of adipose-derived mesenchymal stem cells (ADSCs) through fat grafting. This review seeks to understand how ADSCs may impact the development and progression of SSc, with a particular focus on how these cells could alter immune responses and reduce fibrosis. ADSCs have been found to affect various immune cells, including T cells, B cells, macrophages, and dendritic cells, by releasing cytokines, chemokines, and growth factors. These interactions generally suppress inflammation and promote a regulatory immune environment. Additionally, ADSCs can influence the extracellular matrix, helping to prevent fibrosis through signaling molecules like exosomes. ADSCs show promise as a treatment for SSc due to their ability to modulate the immune system and reduce fibrosis. Early clinical studies are encouraging, but more research is needed to fully understand how they work and to develop effective treatment protocols.

Nipple-areola complex (NAC) necrosis remains a challenging complication following nipple-sparing mastectomy, with significant emotional and aesthetic consequences for patients. Full-thickness skin grafting (FTSG) offers a viable reconstructive option in secondary procedures. We report our experience using PICO™ single-use negative pressure wound therapy (NPWT), applied directly over the breast, to enhance graft take in three consecutive cases of nipple reconstruction using groin-derived FTSG. The technique was effective, cost-conscious, and well-tolerated by patients during the recovery period.